Provider Demographics
NPI:1912661976
Name:GAY M JENSEN, RDH, PLLC
Entity Type:Organization
Organization Name:GAY M JENSEN, RDH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:GAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, PLLC
Authorized Official - Phone:360-791-9969
Mailing Address - Street 1:3701 PACIFIC AVE SE STE 317
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2124
Mailing Address - Country:US
Mailing Address - Phone:360-791-9969
Mailing Address - Fax:866-724-7980
Practice Address - Street 1:16422 GIBSON RD SW
Practice Address - Street 2:
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589-9719
Practice Address - Country:US
Practice Address - Phone:360-791-9969
Practice Address - Fax:866-742-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty