Individual provider Active NPI

Carl Sees Jenkins, DDS MS FAGD

  • General Practice Dentistry
  • Watsontown, PA
National Provider Identifier
1003835828
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS-027565-L Issued in PA
Practice address
315 Main St
Watsontown, PA 17777-1618
Phone
(570) 538-5005
Fax
(570) 538-1808
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS-027565-L PA Primary

Addresses

Primary practice location

315 Main St
Watsontown, PA 17777-1618

Mailing address

315 Main St
Watsontown, PA 17777-1618
Phone (570) 538-5005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191114001873 PA Order and Referring Only - DentistPractitioner - Dentist 6103258009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
DS-027565-LPAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003835828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 MAIN ST",
            "city": "WATSONTOWN",
            "state": "PA",
            "postal_code": "177771618",
            "telephone_number": "570-538-5005",
            "fax_number": "570-538-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 MAIN ST",
            "city": "WATSONTOWN",
            "state": "PA",
            "postal_code": "177771618",
            "telephone_number": "570-538-5005",
            "fax_number": "570-538-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "CARL",
        "middle_name": "SEES",
        "name_prefix": "Dr.",
        "credential": "DDS MS FAGD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-027565-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watsontown, PA

Sources for this page

Verify at the official NPI Registry.