Provider Demographics
NPI:1891900312
Name:JENSEN, CHAD ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ERIC
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:120 WHITCOMB AVE
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-1080
Mailing Address - Country:US
Mailing Address - Phone:530-346-6244
Mailing Address - Fax:530-346-6001
Practice Address - Street 1:120 WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-1080
Practice Address - Country:US
Practice Address - Phone:530-346-6244
Practice Address - Fax:530-346-6001
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice