Provider Demographics
NPI:1083777122
Name:HERMES-JENSEN, JANE MARY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MARY
Last Name:HERMES-JENSEN
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2480 WHITE BEAR AVE N
Mailing Address - Street 2:STE 201
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 1:1937 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3926
Practice Address - Country:US
Practice Address - Phone:651-738-9050
Practice Address - Fax:651-770-9199
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND84621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics