Provider Demographics
NPI:1255376281
Name:JENSEN, ROBERT T (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
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 1:7100 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4227
Mailing Address - Country:US
Mailing Address - Phone:937-435-1555
Mailing Address - Fax:
Practice Address - Street 1:7100 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4227
Practice Address - Country:US
Practice Address - Phone:937-435-1555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics