Healthcare Provider Details

I. General information

NPI: 1821098682
Provider Name (Legal Business Name): OLE T JENSEN D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

8200 E BELLEVIEW AVE #520E
GREENWOOD VILLAGE CO
80111-2803
US

IV. Provider business mailing address

8200 E BELLEVIEW AVE #520E
GREENWOOD VILLAGE CO
80111-2803
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-0303
  • Fax: 303-322-7326
Mailing address:
  • Phone: 303-388-0303
  • Fax: 303-322-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number104736
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: