Provider Demographics
NPI:1124124912
Name:JENKINS, LESLIE ARTHUR (DMD)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:ARTHUR
Last Name:JENKINS
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:PO BOX 692
Mailing Address - Street 2:3282 SOUTH MAIN ST
Mailing Address - City:SANDY LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16145
Mailing Address - Country:US
Mailing Address - Phone:724-376-2930
Mailing Address - Fax:724-376-2121
Practice Address - Street 1:3282 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDY LAKE
Practice Address - State:PA
Practice Address - Zip Code:16145
Practice Address - Country:US
Practice Address - Phone:724-376-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021219L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018774800001Medicaid