=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760325187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHET JENKINS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2026
-----------------------------------------------------
Last Update Date | 04/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 UNION AVE SE
-----------------------------------------------------
City | OLYMPIA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98501-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-943-6111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 N 44TH ST STE 600
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85008-7616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-234-8490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF TRAINING AND INTEGRATIONS
-----------------------------------------------------
Name | MELODY BENNION
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-234-8490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------