Provider Demographics
NPI:1801267018
Name:JESSEN'S FAMILY DENTISTRY AND DENTAL HYGIENE, P.C
Entity type:Organization
Organization Name:JESSEN'S FAMILY DENTISTRY AND DENTAL HYGIENE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-589-1313
Mailing Address - Street 1:104 N.THAYER ST.
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NE
Mailing Address - Zip Code:68777-0287
Mailing Address - Country:US
Mailing Address - Phone:402-589-1303
Mailing Address - Fax:
Practice Address - Street 1:104 N.THAYER ST.
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NE
Practice Address - Zip Code:68777-0287
Practice Address - Country:US
Practice Address - Phone:402-589-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental