Provider Demographics
NPI:1750986709
Name:JENKINS ARIZONA DENTAL PARTNERS PC
Entity type:Organization
Organization Name:JENKINS ARIZONA DENTAL PARTNERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR INTEGRATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-234-8490
Mailing Address - Street 1:410 N 44TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7622
Mailing Address - Country:US
Mailing Address - Phone:480-234-8490
Mailing Address - Fax:
Practice Address - Street 1:18275 N 59TH AVE # D-120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-973-7204
Practice Address - Fax:602-943-1534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE DENTAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental