Provider Demographics
NPI:1548609845
Name:JENSEN, DENNIS LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LAWRENCE
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 1:8228 MAYFIELD RD # 2B
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2594
Mailing Address - Country:US
Mailing Address - Phone:440-729-1914
Mailing Address - Fax:
Practice Address - Street 1:8228 MAYFIELD RD # 2B
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2594
Practice Address - Country:US
Practice Address - Phone:440-729-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-1-8633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist