Provider Demographics
NPI:1942494083
Name:JENSEN, BRANDON CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHARLES
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 1:4046 SOUTH HIGHLAND DRIVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1689
Mailing Address - Country:US
Mailing Address - Phone:801-272-9003
Mailing Address - Fax:
Practice Address - Street 1:4046 SOUTH HIGHLAND DRIVE
Practice Address - Street 2:SUITE 113
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1689
Practice Address - Country:US
Practice Address - Phone:801-272-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66815651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice