Provider Demographics
NPI:1407395635
Name:BRETT JENSEN, DDS, INC.
Entity Type:Organization
Organization Name:BRETT JENSEN, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-983-9929
Mailing Address - Street 1:2545 E BIDWELL ST STE 120
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6443
Mailing Address - Country:US
Mailing Address - Phone:916-983-9929
Mailing Address - Fax:916-983-3336
Practice Address - Street 1:2545 E BIDWELL ST STE 120
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6443
Practice Address - Country:US
Practice Address - Phone:916-983-9929
Practice Address - Fax:916-983-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty