Provider Demographics
NPI:1699730135
Name:THE PROVINCES DENTAL CARE
Entity type:Organization
Organization Name:THE PROVINCES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHET
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-792-6880
Mailing Address - Street 1:1070 E RAY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1771
Mailing Address - Country:US
Mailing Address - Phone:480-792-6880
Mailing Address - Fax:480-792-6870
Practice Address - Street 1:1070 E RAY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1771
Practice Address - Country:US
Practice Address - Phone:480-792-6880
Practice Address - Fax:480-792-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty