Active NPI
Conrad B Jenkins, DDS
- Public Health Dentistry
- Charlottesville, VA
National Provider Identifier
1740290394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 0401005559
- Practice address
- 1138 Rose Hill Dr
Charlottesville, VA 22903-5128 - Phone
- (434) 972-6233
- Fax
- (434) 972-4310
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 0401005559 | VA | Primary |
Addresses
Primary practice location
1138 Rose Hill Dr
Charlottesville, VA 22903-5128
Mailing address
PO Box 7546
Charlottesville, VA 22906-7546
Phone (434) 972-6233
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0013970 | Other | VA | DORAL DENTAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401005559 | VA | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226880000000",
"number": "1740290394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7546",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229067546",
"telephone_number": "434-972-6233",
"fax_number": "434-972-4310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1138 ROSE HILL DR",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229035128",
"telephone_number": "434-972-6233",
"fax_number": "434-972-4310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "CONRAD",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-08",
"last_updated": "2008-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "VA",
"license": "0401005559",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL",
"identifier": "0013970",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.