Healthcare Provider Details

I. General information

NPI: 1053443721
Provider Name (Legal Business Name): MARK ALLEN JENSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 EAST CALL STREET
ALGONA IA
50511
US

IV. Provider business mailing address

208 EAST CALL STREET
ALGONA IA
50511
US

V. Phone/Fax

Practice location:
  • Phone: 515-295-2303
  • Fax: 515-295-2011
Mailing address:
  • Phone: 515-295-2303
  • Fax: 515-295-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6771
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: