Provider Demographics
NPI:1821098682
Name:JENSEN, OLE T (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:OLE
Middle Name:T
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:#520E
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:303-388-0303
Mailing Address - Fax:303-322-7326
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:#520E
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-388-0303
Practice Address - Fax:303-322-7326
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2016-06-13
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
UT1047361223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840830469Medicare UPIN