Provider Demographics
NPI:1881096279
Name:TERRY M. JENSEN
Entity type:Organization
Organization Name:TERRY M. JENSEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-887-5214
Mailing Address - Street 1:322 M ST
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-1421
Mailing Address - Country:US
Mailing Address - Phone:402-887-5214
Mailing Address - Fax:402-887-4904
Practice Address - Street 1:322 M ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1421
Practice Address - Country:US
Practice Address - Phone:402-887-5214
Practice Address - Fax:402-887-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid