Provider Demographics
NPI:1578686325
Name:DR MONTEL R JENKINS DMD PS
Entity Type:Organization
Organization Name:DR MONTEL R JENKINS DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-228-6780
Mailing Address - Street 1:212 PARK AVENUE 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 AVENUE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004505261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental