Healthcare Provider Details

I. General information

NPI: 1285063297
Provider Name (Legal Business Name): CHAD JENSEN DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST
HARRISON AR
72601-3536
US

IV. Provider business mailing address

500 N MAIN ST
HARRISON AR
72601-3536
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-4746
  • Fax:
Mailing address:
  • Phone: 870-741-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3968
License Number StateAR

VIII. Authorized Official

Name: DR. CHAD ERICK JENSEN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 801-358-4479