MEDICARE: DR MONTEL R JENKINS DMD PS

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	261QD0000X	Dental Clinic/Center	DE00004505	WA

General Provider Information

NPI Number	:	1578686325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MONTEL R JENKINS DMD PS

Provider Business Mailing Address
First Line	:	212 PARK AVENUE NORTH
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-5717
Country	:	US
Telephone Number	:	425-228-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 PARK AVENUE NORTH
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-5717
Country	:	US
Telephone Number	:	425-228-6780
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MONTEL R JENKINS
Credential	:	DMD
Telephone Number	:	425-228-6780

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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