Provider Demographics
NPI:1225178700
Name:JENSEN, PAUL M (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
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 1:1120 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-2803
Mailing Address - Country:US
Mailing Address - Phone:541-994-8935
Mailing Address - Fax:541-994-9270
Practice Address - Street 1:1120 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-2803
Practice Address - Country:US
Practice Address - Phone:541-994-8935
Practice Address - Fax:541-994-9270
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice