Basic Information
| Provider Information | |||||||||
| NPI: | 1740514413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | WANG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339021357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392783600 | ||||||||
| FaxNumber: | 2393322680 | ||||||||
| Practice Location | |||||||||
| Address1: | 8359 STRINGFELLOW RD | ||||||||
| Address2: | |||||||||
| City: | ST JAMES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339562910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393442393 | ||||||||
| FaxNumber: | 2392839276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2009 | ||||||||
| LastUpdateDate: | 12/09/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN18874 | FL | N | Dental Providers | Dentist | 122300000X | 0401412645 | VA | Y | Dental Providers | Dentist |
No ID Information.