Provider Demographics
NPI:1477805836
Name:JENSEN, CHAD E (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 HIGHWAY 65 N
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-1934
Mailing Address - Country:US
Mailing Address - Phone:870-741-4746
Mailing Address - Fax:870-741-7097
Practice Address - Street 1:1523 HIGHWAY 65 N
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1934
Practice Address - Country:US
Practice Address - Phone:801-358-4479
Practice Address - Fax:801-358-4479
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3968122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist