Provider Demographics
NPI:1982703427
Name:JENSEN, MATTHEW O (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:O
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15331 W BELL RD
Mailing Address - Street 2:SUITE #112
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:602-730-6481
Mailing Address - Fax:602-730-6482
Practice Address - Street 1:15331 W BELL RD STE 112
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4103
Practice Address - Country:US
Practice Address - Phone:602-730-6481
Practice Address - Fax:602-730-6482
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5347421-99231223P0221X
AZD0089301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry