1881774081 NPI number — UNIVERSITY DENTAL ASSOCIATES

Table of content: DR. BRENDEN PATRICK JENKS MD (NPI 1598323719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881774081 NPI number — UNIVERSITY DENTAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY DENTAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881774081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4526 15TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98105-4507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-523-8094
Provider Business Mailing Address Fax Number:
206-522-4634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4526 15TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-523-8094
Provider Business Practice Location Address Fax Number:
206-522-4634
Provider Enumeration Date:
10/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WARE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-523-8094

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00003310 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)