Provider Demographics
NPI:1992089882
Name:JENKINS AND STOPPER, DDS, PA
Entity type:Organization
Organization Name:JENKINS AND STOPPER, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-246-8888
Mailing Address - Street 1:422 E 2ND ST UNIT 2
Mailing Address - Street 2:P.O. BOX 387
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9757
Mailing Address - Country:US
Mailing Address - Phone:336-246-8888
Mailing Address - Fax:336-846-3138
Practice Address - Street 1:422 E 2ND ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9757
Practice Address - Country:US
Practice Address - Phone:336-246-8888
Practice Address - Fax:336-846-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42081223G0001X
NC84451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994553Medicaid