Provider Demographics
NPI:1093933244
Name:JENSEN, LEONARD MEYER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MEYER
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 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 704 MED ARTS BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-496-0481
Mailing Address - Fax:215-496-9887
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 704 MED ARTS BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-496-0481
Practice Address - Fax:215-496-9887
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019979L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice