Provider Demographics
NPI:1720553993
Name:MICHAEL JENSEN DMD PC
Entity Type:Organization
Organization Name:MICHAEL JENSEN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNEER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-253-9542
Mailing Address - Street 1:406 SE 131ST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4013
Mailing Address - Country:US
Mailing Address - Phone:360-253-9542
Mailing Address - Fax:360-253-9589
Practice Address - Street 1:406 SE 131ST AVE STE 202
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4013
Practice Address - Country:US
Practice Address - Phone:360-253-9542
Practice Address - Fax:360-253-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental