Provider Demographics
NPI:1174882328
Name:RALPH K JENKE DDS & ASSOCIATES PA DBA POLK COUNTY DENTAL CARE
Entity type:Organization
Organization Name:RALPH K JENKE DDS & ASSOCIATES PA DBA POLK COUNTY DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:JENKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-327-7477
Mailing Address - Street 1:1114 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-2336
Mailing Address - Country:US
Mailing Address - Phone:936-327-7477
Mailing Address - Fax:936-327-7479
Practice Address - Street 1:1114 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2336
Practice Address - Country:US
Practice Address - Phone:936-327-7477
Practice Address - Fax:936-327-7479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALPH K JENKE DDS & ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty