Healthcare Provider Details

I. General information

NPI: 1992589303
Provider Name (Legal Business Name): JENSEN PECORA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 N ROCHESTER RD STE 101
ROCHESTER HILLS MI
48307-1188
US

IV. Provider business mailing address

45739 IRVINE DR
NOVI MI
48374-3776
US

V. Phone/Fax

Practice location:
  • Phone: 248-230-2455
  • Fax:
Mailing address:
  • Phone: 248-924-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901602831
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: