Provider Demographics
NPI:1932277977
Name:JENSEN, HOWARD P (DDS)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:P
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 1:11 105TH AVE SE STE 11
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6281
Mailing Address - Country:US
Mailing Address - Phone:425-454-7690
Mailing Address - Fax:425-454-2172
Practice Address - Street 1:11 105TH AVE SE
Practice Address - Street 2:STE 11
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6281
Practice Address - Country:US
Practice Address - Phone:425-454-7690
Practice Address - Fax:425-454-2172
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice