Provider Demographics
NPI:1720579097
Name:JENSEN, CARA (RDH)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 NW KIACUT RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:OR
Mailing Address - Zip Code:97119-8009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE STE 228
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1803
Practice Address - Country:US
Practice Address - Phone:503-585-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist