Healthcare Provider Details

I. General information

NPI: 1114022548
Provider Name (Legal Business Name): JEAN ANNE JENSEN DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 MAIN ST
SHELBYVILLE KY
40065-1601
US

IV. Provider business mailing address

1415 MAIN ST
SHELBYVILLE KY
40065-1601
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-4613
  • Fax:
Mailing address:
  • Phone: 502-633-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: