Provider Demographics
NPI:1235582545
Name:JENSEN & BROWN, DDS
Entity Type:Organization
Organization Name:JENSEN & BROWN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-454-7690
Mailing Address - Street 1:11 105TH AVE SE STE 11
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6281
Mailing Address - Country:US
Mailing Address - Phone:425-454-7690
Mailing Address - Fax:
Practice Address - Street 1:11 105TH AVE SE STE 11
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6281
Practice Address - Country:US
Practice Address - Phone:425-454-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1780706580Medicaid