Provider Demographics
NPI:1619044252
Name:JENSEN, DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
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 1:47 CRESTWOOD RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1445
Mailing Address - Country:US
Mailing Address - Phone:801-546-2439
Mailing Address - Fax:801-546-0759
Practice Address - Street 1:47 CRESTWOOD RD
Practice Address - Street 2:SUITE #3
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037
Practice Address - Country:US
Practice Address - Phone:801-544-4204
Practice Address - Fax:801-546-6140
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3224021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice