Provider Demographics
NPI:1821227596
Name:B.D. JENSEN PROF. LLC
Entity Type:Organization
Organization Name:B.D. JENSEN PROF. LLC
Other - Org Name:HEARTLAND SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-665-7479
Mailing Address - Street 1:158 HIDDEN HOLLOWS DR
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-6781
Mailing Address - Country:US
Mailing Address - Phone:605-665-7479
Mailing Address - Fax:605-260-7410
Practice Address - Street 1:117 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-2257
Practice Address - Country:US
Practice Address - Phone:605-624-0070
Practice Address - Fax:605-624-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty