Provider Demographics
NPI:1912153214
Name:JENSEN, DOUGLAS
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 S CUSTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6554
Mailing Address - Country:US
Mailing Address - Phone:214-842-8106
Mailing Address - Fax:
Practice Address - Street 1:3595 S CUSTER RD STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6554
Practice Address - Country:US
Practice Address - Phone:214-842-8106
Practice Address - Fax:214-842-8109
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208921223P0700X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0700XDental ProvidersDentistProsthodontics