MEDICARE: DR. ALVIN PHILLIPS JENKINS 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
1	1223G0001X	General Practice Dentistry	4208	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	94553	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275547952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALVIN PHILLIPS JENKINS D.D.S.

Provider Business Mailing Address
First Line	:	420 E. SECOND ST.
Second Line	:	P. O. BOX 387
City	:	WEST JEFFERSON
State	:	NC
Zip	:	28694-0387
Country	:	US
Telephone Number	:	336-246-8888
Fax Number	:	336-846-3138

Provider Business Practice Location Address
First Line	:	420 E. SECOND ST.
Second Line	:
City	:	WEST JEFFERSON
State	:	NC
Zip	:	28694-0387
Country	:	US
Telephone Number	:	336-246-8888
Fax Number	:	336-846-3138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ALVIN PHILLIPS JENKINS D.D.S.” Practice Location

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