Provider Demographics
NPI:1205003506
Name:RESTORATION DENTAL, P.C.
Entity Type:Organization
Organization Name:RESTORATION DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:JERALD
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-440-3393
Mailing Address - Street 1:5465 MILLS CIVIC PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5318
Mailing Address - Country:US
Mailing Address - Phone:515-440-3393
Mailing Address - Fax:515-440-1159
Practice Address - Street 1:5465 MILLS CIVIC PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5318
Practice Address - Country:US
Practice Address - Phone:515-440-3393
Practice Address - Fax:515-440-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07847261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental