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General NPI Number Information
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NPI Number | 1861320384
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Entity Type | Organization
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Legal Business Name | WEST CLINTON FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 250 W CLINTON ST STE 5
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City | GRAY
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State | GA
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Zip | 31032-5463
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Country | US
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Telephone | 478-986-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 250 W CLINTON ST STE 5
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City | GRAY
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State | GA
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Zip | 31032-5463
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Country | US
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Telephone | 478-986-1830
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST/OWNER
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Name | DR. JACOB A. JENKINS
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Credential | DMD
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Telephone | 206-458-8422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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