Shane Alan Jenks, D.M.D

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2015004756 Issued in MO

Practice address

8291 N Booth Ave
Kansas City, MO 64158-7202

Phone

(816) 728-2979

NPI assigned

Oct 27, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Bryan Watanabe DDS Liberty Dental Group PC

  dba Liberty Oaks Dental Group

  • General Practice Dentistry
  • Kansas City, MO
  • NPI 1780056135
  NPD (past)
• Legends Dental Group, P.a.

  dba Legends Dental Group and Orthodontics

  • General Practice Dentistry
  • Kansas City, KS
  • NPI 1033559570
  NPD (past)

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679873434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8291 N BOOTH AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641587202",
            "telephone_number": "816-728-2979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8291 N BOOTH AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641587202",
            "telephone_number": "816-728-2979"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 Gillham Rd",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641084619",
            "country_code": "US",
            "telephone_number": "816-855-1867",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10818 Parallel Pkwy",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "KS",
            "postal_code": "661093649",
            "country_code": "US",
            "telephone_number": "913-299-8860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENKS",
        "first_name": "SHANE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KS",
            "license": "61352",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "2015004756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nia J Jenkins, M.D.
• Paul W Jenkins, PA-C
• Stephanie Jenkins
• Taylor Nykole Jenkins
• Robin M Jenks, PLPC
• Jennifer Worth MSW, LCSW, LLC (Worth It)
• Bryan Jennings, PHARM.D
• David Jennings
• Hope Jennings
• Katherine Elizabeth Jennings, PA-C

• Pediatric Dentistry in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.