Provider Demographics
NPI:1205913035
Name:JESSEN, F. ZANE (DDS)
Entity type:Individual
Prefix:DR
First Name:F.
Middle Name:ZANE
Last Name:JESSEN
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 1:1508 E SKYLINE DR STE 800
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4889
Mailing Address - Country:US
Mailing Address - Phone:801-479-8200
Mailing Address - Fax:801-479-3219
Practice Address - Street 1:1508 E SKYLINE DR STE 800
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4889
Practice Address - Country:US
Practice Address - Phone:801-479-8200
Practice Address - Fax:801-479-3219
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT48825Medicare UPIN