Provider Demographics
NPI:1750937124
Name:DR. COLLEEN JENSON, LLC
Entity type:Organization
Organization Name:DR. COLLEEN JENSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-532-1007
Mailing Address - Street 1:825 CASPIAN CT E
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2844
Mailing Address - Country:US
Mailing Address - Phone:719-650-7470
Mailing Address - Fax:
Practice Address - Street 1:1155 KELLY JOHNSON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3958
Practice Address - Country:US
Practice Address - Phone:719-532-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. COLLEEN JENSON, LLC/DBA GRACE DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental