Healthcare Provider Details

I. General information

NPI: 1477805836
Provider Name (Legal Business Name): CHAD E JENSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 HIGHWAY 65 N
HARRISON AR
72601-1934
US

IV. Provider business mailing address

1523 HIGHWAY 65 N
HARRISON AR
72601-1934
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-4479
  • Fax: 801-358-4479
Mailing address:
  • Phone: 870-741-4746
  • Fax: 870-741-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: