Provider Demographics
NPI:1831438787
Name:JENSEN, MATTHEW T (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
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 1:10214 N TATUM BLVD STE B600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4299
Mailing Address - Country:US
Mailing Address - Phone:602-899-0488
Mailing Address - Fax:
Practice Address - Street 1:10214 N TATUM BLVD STE B600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4299
Practice Address - Country:US
Practice Address - Phone:602-899-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0093931223G0001X, 1223S0112X
NJ22DI025749001223G0001X
NY057466-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice