Provider Demographics
NPI:1558833459
Name:ALLISON JENSEN, DMD, PC
Entity Type:Organization
Organization Name:ALLISON JENSEN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-232-4076
Mailing Address - Street 1:112 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2125
Mailing Address - Country:US
Mailing Address - Phone:630-232-4076
Mailing Address - Fax:
Practice Address - Street 1:112 N 4TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2125
Practice Address - Country:US
Practice Address - Phone:630-232-4076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental