MEDICARE: MASON LEE 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	122300000X	Dentist	D1519	SD

General Provider Information

NPI Number	:	1528991023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON LEE JENSEN DDS

Provider Business Mailing Address
First Line	:	503 JACKSON ST
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1716
Country	:	US
Telephone Number	:	605-892-6347
Fax Number	:	605-892-9027

Provider Business Practice Location Address
First Line	:	503 JACKSON ST
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1716
Country	:	US
Telephone Number	:	605-892-6347
Fax Number	:	605-892-9027

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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