Provider Demographics
NPI:1336192442
Name:JENSEN, DENNIS M (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23351 PRAIRIE STAR PKWY STE A245
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-7301
Mailing Address - Country:US
Mailing Address - Phone:913-676-8630
Mailing Address - Fax:913-676-8635
Practice Address - Street 1:23351 PRAIRIE STAR PKWY STE A245
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-7301
Practice Address - Country:US
Practice Address - Phone:913-676-8630
Practice Address - Fax:913-676-8635
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24070207Q00000X
NV15124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC240705Medicaid
SCH95571Medicare UPIN
SC240705Medicaid