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NPI Code Detail

MEDICARE: DR. DENVER D. JENKINS JR. D.D.S.

MEDICARE: DR. DENVER D. JENKINS JR. D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist19214OH

General Provider Information

NPI Number : 1174710016
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENVER D. JENKINS JR. D.D.S.
Provider Business Mailing Address
First Line : 17117 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-3622
Country : US
Telephone Number : 216-221-3368
Fax Number : 216-221-3368
Provider Business Practice Location Address
First Line : 17117 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-3622
Country : US
Telephone Number : 216-221-3368
Fax Number : 216-221-3368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2007
Last Update Date : 07/10/2008

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