Provider Demographics
NPI:1699937847
Name:TANEK L. JENKINS, DDS
Entity type:Organization
Organization Name:TANEK L. JENKINS, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANEK
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-686-0710
Mailing Address - Street 1:6710 OXON HILL RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1117
Mailing Address - Country:US
Mailing Address - Phone:301-686-0710
Mailing Address - Fax:301-686-0740
Practice Address - Street 1:6710 OXON HILL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1117
Practice Address - Country:US
Practice Address - Phone:301-686-0710
Practice Address - Fax:301-686-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty