Active NPI
Damon Jenkins, DMD
- Prosthodontics
- Manchester, CT
National Provider Identifier
1891890463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 009646
- Practice address
- 483 West Middle Turnpike
Manchester, CT 06040 - Phone
- (860) 645-0111
- Fax
- (860) 533-9027
- NPI assigned
- Sep 14, 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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 009646 | CT | Primary |
Addresses
Primary practice location
483 West Middle Turnpike
Manchester, CT 06040
Mailing address
39 Buckland Street
Unit 1033-4
Manchester, CT 06040
Phone (504) 400-0682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150327000397 | CT | Order and Referring Only - Dentist | 0941527121 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009646 | CT | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891890463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 BUCKLAND STREET",
"address_2": "UNIT 1033-4",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "06040",
"telephone_number": "504-400-0682",
"fax_number": "860-533-9027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "483 WEST MIDDLE TURNPIKE",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "06040",
"telephone_number": "860-645-0111",
"fax_number": "860-533-9027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "DAMON",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CT",
"license": "009646",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.