# JENKINS FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821105081
- **Authorized official:** BRAD R JENKINS DDS (OWNER)
- **Authorized official phone:** (785) 743-2481

## Contact information

- **Practice address:** 531 RUSSELL, WAKEENEY, KS 67672
- **Practice address phone:** (785) 743-2481
- **Practice address fax:** (785) 743-5455
- **Mailing address:** PO BOX 276, WAKEENEY, KS 67672
- **Mailing address phone:** (785) 743-2481
- **Mailing address fax:** (785) 743-5455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7195 | KS | Yes |

## Other

- **Enumeration date:** 08/24/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 116568 | BLUE CROSS BLUE SHIELD | — |