Provider Demographics
NPI:1053443721
Name:JENSEN, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 EAST CALL STREET
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511
Mailing Address - Country:US
Mailing Address - Phone:515-295-2303
Mailing Address - Fax:515-295-2011
Practice Address - Street 1:208 EAST CALL STREET
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511
Practice Address - Country:US
Practice Address - Phone:515-295-2303
Practice Address - Fax:515-295-2011
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice