MEDICARE: DR. JENNIFER KATHERINE KING DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE000008213	WA

General Provider Information

NPI Number	:	1083693451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER KATHERINE KING DDS

Provider Business Mailing Address
First Line	:	109 WEST YAKIMA AVENUE
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942
Country	:	US
Telephone Number	:	509-697-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W YAKIMA AVE
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1364
Country	:	US
Telephone Number	:	509-697-4821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	11/24/2020

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