Provider Demographics
NPI:1699108753
Name:JENKINS, JOSHUA STEVEN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:STEVEN
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 1:210 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2704
Mailing Address - Country:US
Mailing Address - Phone:770-474-3418
Mailing Address - Fax:
Practice Address - Street 1:210 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2704
Practice Address - Country:US
Practice Address - Phone:770-474-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60551223G0001X
GADN0146521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice