Provider Demographics
NPI:1710979125
Name:JENSEN, WILLIS J II (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:J
Last Name:JENSEN
Suffix:II
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 1:502 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1935
Mailing Address - Country:US
Mailing Address - Phone:847-577-7440
Mailing Address - Fax:854-577-9125
Practice Address - Street 1:502 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1935
Practice Address - Country:US
Practice Address - Phone:847-577-7440
Practice Address - Fax:854-577-9125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL-16311-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist