1992089882 NPI number — JENKINS AND STOPPER, DDS, PA

Table of content: (NPI 1992089882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992089882 NPI number — JENKINS AND STOPPER, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENKINS AND STOPPER, DDS, PA
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:
ALVIN P. JENKINS, D.D.S., P.A.
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:
1992089882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 E 2ND ST UNIT 2
Provider Second Line Business Mailing Address:
P.O. BOX 387
Provider Business Mailing Address City Name:
WEST JEFFERSON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28694-9757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-246-8888
Provider Business Mailing Address Fax Number:
336-846-3138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 E 2ND ST UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28694-9757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-246-8888
Provider Business Practice Location Address Fax Number:
336-846-3138
Provider Enumeration Date:
10/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
STOPPER
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
336-246-8888

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4208 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 8445 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8994553 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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