MEDICARE: JENNIFER K. KING, DDS, PLLC

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		WA

General Provider Information

NPI Number	:	1528139698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER K. KING, DDS, PLLC

Provider Business Mailing 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	:	509-697-7285

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	:	509-697-7285

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER KATHERINE KING
Credential	:	D.D.S.
Telephone Number	:	509-697-4821

Provider Enumeration Date	:	11/12/2006
Last Update Date	:	08/22/2020

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