Provider Demographics
NPI:1477674638
Name:JENSEN, JON DARREL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DARREL
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 1:812 5TH AVE N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-6123
Mailing Address - Country:US
Mailing Address - Phone:206-284-0566
Mailing Address - Fax:206-284-0573
Practice Address - Street 1:812 5TH AVE N
Practice Address - Street 2:SUITE 4
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-6123
Practice Address - Country:US
Practice Address - Phone:206-284-0566
Practice Address - Fax:206-284-0573
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA75531223G0001X
CA403601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice