Provider Demographics
NPI:1952343600
Name:DOUGLAS M JENSEN DDS PC
Entity Type:Organization
Organization Name:DOUGLAS M JENSEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-772-2392
Mailing Address - Street 1:1332 LINDEN ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3257
Mailing Address - Country:US
Mailing Address - Phone:303-772-2392
Mailing Address - Fax:303-772-2438
Practice Address - Street 1:1332 LINDEN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3257
Practice Address - Country:US
Practice Address - Phone:303-772-2392
Practice Address - Fax:303-772-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD1009591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty