Provider Demographics
NPI:1023246634
Name:JENKINSON, JEFFREY ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:JENKINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1108
Mailing Address - Country:US
Mailing Address - Phone:864-332-1266
Mailing Address - Fax:864-261-6988
Practice Address - Street 1:4130 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1108
Practice Address - Country:US
Practice Address - Phone:864-332-1266
Practice Address - Fax:864-261-6988
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice