Provider Demographics
NPI:1598866469
Name:JENSEN, JAY D (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:D
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 1:3098 S HIGHLAND DR
Mailing Address - Street 2:STE 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3618
Mailing Address - Country:US
Mailing Address - Phone:801-467-9111
Mailing Address - Fax:
Practice Address - Street 1:2043 E 2700 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1720
Practice Address - Country:US
Practice Address - Phone:801-467-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1391071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice