{
"Npi": {
"NPI": "1760325187",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SIGNATURE DENTAL PARTNERS LLC",
"ParentOrgTIN": null,
"OrgName": "CHET JENKINS PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "410 N 44TH ST STE 600",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85008-7616",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-234-8490",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1010 UNION AVE SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OLYMPIA",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98501-1545",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-943-6111",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/10/2026",
"LastUpdateDate": "04/10/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BENNION",
"AuthorizedOfficialFirstName": "MELODY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP OF TRAINING AND INTEGRATIONS",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "480-234-8490",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223D0001X",
"TaxonomyName": "Public Health Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}