MEDICARE: JAREN TOLMAN JENSEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	D7457	AZ
2	1223P0221X	Pediatric Dentistry	S6-100	NV

General Provider Information

NPI Number	:	1225207251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAREN TOLMAN JENSEN DDS

Provider Business Mailing Address
First Line	:	9500 W FLAMINGO RD
Second Line	:	#200
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-5719
Country	:	US
Telephone Number	:	702-614-1792
Fax Number	:

Provider Business Practice Location Address
First Line	:	3896 N MARTIN L KING BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6603
Country	:	US
Telephone Number	:	702-614-1792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2008
Last Update Date	:	08/18/2010

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