Provider Demographics
NPI:1275644684
Name:JENSEN, MARK ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17705 HUTCHINS DR
Mailing Address - Street 2:#207
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4176
Mailing Address - Country:US
Mailing Address - Phone:952-474-6600
Mailing Address - Fax:952-380-0603
Practice Address - Street 1:17705 HUTCHINS DR
Practice Address - Street 2:#207
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4176
Practice Address - Country:US
Practice Address - Phone:952-474-6600
Practice Address - Fax:952-380-0603
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN82991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics