MEDICARE: STEPHANIE Q JENKINS DDS PA

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	122300000X	Dentist	6714	NC

General Provider Information

NPI Number	:	1992783815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE Q JENKINS DDS PA

Provider Business Mailing Address
First Line	:	5317 HIGHGATE DR
Second Line	:	SUITE 118
City	:	DURHAM
State	:	NC
Zip	:	27713-6622
Country	:	US
Telephone Number	:	919-361-0500
Fax Number	:	919-544-4990

Provider Business Practice Location Address
First Line	:	5317 HIGHGATE DR
Second Line	:	SUITE 118
City	:	DURHAM
State	:	NC
Zip	:	27713-6622
Country	:	US
Telephone Number	:	919-361-0500
Fax Number	:	919-544-4990

Authorized Official
Title or Position	:	DENTIST
Name	:	STEPHANIE JENKINS
Credential	:	DDS PA
Telephone Number	:	919-361-0500

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	08/22/2020

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