Provider Demographics
NPI:1235252099
Name:JENKINS, MONTEL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONTEL
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PARK AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5717
Mailing Address - Country:US
Mailing Address - Phone:425-228-6780
Mailing Address - Fax:
Practice Address - Street 1:212 PARK AVE NORTH
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5717
Practice Address - Country:US
Practice Address - Phone:425-228-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist