Provider Demographics
NPI:1912142894
Name:JENSEN, MARK S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
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 1:8901 W 74TH ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2238
Mailing Address - Country:US
Mailing Address - Phone:913-384-2242
Mailing Address - Fax:913-384-4685
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:SUITE 245
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2238
Practice Address - Country:US
Practice Address - Phone:913-384-2242
Practice Address - Fax:913-384-4685
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS383189OtherBCBS OF KANSAS
KS17844026OtherBCBS OF KANSAS CITY
KS17844026OtherBCBS OF KANSAS CITY