MEDICARE: JENNIFER M. JENKINS, DDS, PC

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	305R00000X	Preferred Provider Organization	6030	OK

General Provider Information

NPI Number	:	1417271115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER M. JENKINS, DDS, PC

Provider Business Mailing Address
First Line	:	6800 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1809
Country	:	US
Telephone Number	:	405-631-7571
Fax Number	:	405-631-3305

Provider Business Practice Location Address
First Line	:	6800 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1809
Country	:	US
Telephone Number	:	405-631-7571
Fax Number	:	405-631-3305

Authorized Official
Title or Position	:	PRESIDENT/ DENTIST
Name	:	DR. JENNIFER M. JENKINS
Credential	:	D.D.S.
Telephone Number	:	405-631-7571

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	07/06/2011

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