Provider Demographics
NPI:1437419546
Name:JANSEN, JOHN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:JANSEN
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 1:710 AVERITT RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6390
Mailing Address - Country:US
Mailing Address - Phone:317-888-6111
Mailing Address - Fax:
Practice Address - Street 1:710 AVERITT RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6390
Practice Address - Country:US
Practice Address - Phone:317-888-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120117494A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice