Provider Demographics
NPI:1003229618
Name:JENSEN, NATHAN JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JOHN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MERIDIAN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2565
Mailing Address - Country:US
Mailing Address - Phone:715-246-2111
Mailing Address - Fax:715-246-2579
Practice Address - Street 1:227 MERIDIAN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2565
Practice Address - Country:US
Practice Address - Phone:715-246-2111
Practice Address - Fax:715-246-2579
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001264-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist