Provider Demographics
NPI:1437275039
Name:JENSEN & JENSEN DDS PA
Entity type:Organization
Organization Name:JENSEN & JENSEN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-770-3014
Mailing Address - Street 1:2480 WHITE BEAR AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4567
Mailing Address - Country:US
Mailing Address - Phone:651-770-3014
Mailing Address - Fax:651-770-9199
Practice Address - Street 1:2480 WHITE BEAR AVE N STE 201
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4567
Practice Address - Country:US
Practice Address - Phone:651-770-3014
Practice Address - Fax:651-770-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND78601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty