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General NPI Number Information
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NPI Number | 1881810737
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Entity Type | Organization
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Legal Business Name | RALPH K JENKE DDS & ASSOCIATES PA
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 414 TYLER ST
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City | LIVINGSTON
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State | TX
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Zip | 77351-2956
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Country | US
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Telephone | 936-327-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 414 TYLER ST
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City | LIVINGSTON
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State | TX
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Zip | 77351-2956
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Country | US
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Telephone | 936-327-5757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH KENNETH JENKE
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Credential | DDS
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Telephone | 936-327-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NULL
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