Healthcare Provider Details

I. General information

NPI: 1023753548
Provider Name (Legal Business Name): CHET JENKINS III PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PL STE 302
SEATTLE WA
98105-4028
US

IV. Provider business mailing address

410 N 44TH ST STE 290
PHOENIX AZ
85008-7622
US

V. Phone/Fax

Practice location:
  • Phone: 206-456-0550
  • Fax:
Mailing address:
  • Phone: 480-234-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELODY BENNION
Title or Position: DIRECTOR OF INTEGRATIONS
Credential:
Phone: 480-234-8490