Healthcare Provider Details

I. General information

NPI: 1396057030
Provider Name (Legal Business Name): ADAM JENSEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E TUDOR RD STE 110
ANCHORAGE AK
99503-7244
US

IV. Provider business mailing address

240 E TUDOR RD STE 110
ANCHORAGE AK
99503-7244
US

V. Phone/Fax

Practice location:
  • Phone: 907-868-3000
  • Fax: 907-802-2935
Mailing address:
  • Phone: 907-868-3000
  • Fax: 907-802-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1511
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1511
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2407
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: