Provider Demographics
NPI:1346569670
Name:JENSEN, SUZANNE (DDS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29401 SUNRISE PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5438
Mailing Address - Country:US
Mailing Address - Phone:909-864-4121
Mailing Address - Fax:
Practice Address - Street 1:23767 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7750
Practice Address - Country:US
Practice Address - Phone:951-924-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist