Active NPI
Diane Watt Jenkins, DMD
- Dentist
- Simpsonville, SC
National Provider Identifier
1982939211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 788
- Practice address
- 110A Hospital Dr
Simpsonville, SC 29681-3226 - Phone
- (864) 757-8820
- NPI assigned
- Oct 5, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8734 | KY | |
| Dentist | 122300000X | 7146 | SC | |
| Dentist | 122300000X | 788 | SC | Primary |
Addresses
Primary practice location
110A Hospital Dr
Simpsonville, SC 29681-3226
Mailing address
110 Villa Rd
Greenville, SC 29615-3010
Phone (864) 282-1935
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8734 | KY | MD | General Practice Dentistry |
| 7146 | SC | MD | Speech-Language Pathologist |
| 788 | SC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periodontics of Greenville | Past | Accepting new patients | |
| Sea Glass Periodontics of Greenville | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Periodontics
- Greenville, SC
- NPI 1306929344
-
- Periodontics
- Greenville, SC
- NPI 1568084408
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432771200000",
"number": "1982939211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 VILLA RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296153010",
"telephone_number": "864-282-1935",
"fax_number": "864-282-1955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110A HOSPITAL DR",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296813226",
"telephone_number": "864-757-8820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "DIANE",
"middle_name": "WATT",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-05",
"last_updated": "2015-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "8734",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "7146",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.