Provider Demographics
NPI:1851598437
Name:JENSEN, DAMON TY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:TY
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAMON
Other - Middle Name:TY
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PSC 455 BOX 208
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540-0003
Mailing Address - Country:US
Mailing Address - Phone:671-483-2239
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL GUAM
Practice Address - Street 2:FARENHOLT AVE, BLDG 50
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910-0140
Practice Address - Country:US
Practice Address - Phone:671-483-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYNOT ISSUED TO DATE122300000X
WY11811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist