1689773343 NPI number — DESIGNING SMILES PSC

Table of content: (NPI 1689773343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689773343 NPI number — DESIGNING SMILES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESIGNING SMILES PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DENNIS J JENKINS DDS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689773343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7709 HIGHWAY 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELLERSBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-246-3386
Provider Business Mailing Address Fax Number:
812-246-1292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7709 HIGHWAY 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELLERSBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-246-3386
Provider Business Practice Location Address Fax Number:
812-246-1292
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
JEROME
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
812-246-3386

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12009023 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12009023 . This is a "DENTIST LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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