Provider Demographics
NPI:1982620233
Name:JENSON, RICHARD HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HOWARD
Last Name:JENSON
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 1:117 W FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2013
Mailing Address - Country:US
Mailing Address - Phone:435-723-8136
Mailing Address - Fax:435-723-5988
Practice Address - Street 1:117 W FOREST ST
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2013
Practice Address - Country:US
Practice Address - Phone:435-723-8136
Practice Address - Fax:435-723-5988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5132387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist