Individual provider Active NPI

Thomas Driskill Jenkins, DDS

  • Pediatric Dentistry
  • Bryant, AR
National Provider Identifier
1124519350
Registry record updated Jul 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4359 Issued in AR
Practice address
3310 Hwy 5 N
Bryant, AR 72019-9031
Phone
(501) 847-7070
NPI assigned
May 23, 2018
Last updated
Jul 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 4359 AR Primary

Addresses

Primary practice location

3310 Hwy 5 N
Bryant, AR 72019-9031

Mailing address

3310 Hwy 5 N
Bryant, AR 72019-9031
Phone (501) 847-7070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20180925001080 LA Order and Referring Only - DentistPractitioner - Dentist 3577814987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4359ARMDPhysical Therapy Assistant
6903LAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Marks Children's Dentistry Pediatric Dentistry PastSince Jun 23, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1124519350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 HWY 5 N",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720199031",
            "telephone_number": "501-847-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 HWY 5 N",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "720199031",
            "telephone_number": "501-847-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "THOMAS",
        "middle_name": "DRISKILL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-23",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "4359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryant, AR

Sources for this page

Verify at the official NPI Registry.