Provider Demographics
NPI:1881498004
Name:CHET JENKINS IV PC
Entity type:Organization
Organization Name:CHET JENKINS IV PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTEGRATIONS
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 600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7616
Mailing Address - Country:US
Mailing Address - Phone:480-234-8490
Mailing Address - Fax:
Practice Address - Street 1:1320 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5349
Practice Address - Country:US
Practice Address - Phone:360-943-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE DENTAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental