Healthcare Provider Details

I. General information

NPI: 1285571935
Provider Name (Legal Business Name): CHET JENKINS II PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15324 MAIN ST E STE A
SUMNER WA
98390-2698
US

IV. Provider business mailing address

410 N 44TH ST STE 600
PHOENIX AZ
85008-7616
US

V. Phone/Fax

Practice location:
  • Phone: 253-242-8566
  • Fax:
Mailing address:
  • Phone: 480-234-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MELODY BENNION
Title or Position: VP
Credential:
Phone: 480-234-8490