Healthcare Provider Details

I. General information

NPI: 1619791019
Provider Name (Legal Business Name): JAMES R JENSEN, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST AVE E
SHAKOPEE MN
55379-1444
US

IV. Provider business mailing address

300 1ST AVE E
SHAKOPEE MN
55379-1444
US

V. Phone/Fax

Practice location:
  • Phone: 952-426-0367
  • Fax:
Mailing address:
  • Phone: 952-426-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONIA PASS
Title or Position: OFFICE MANAGER
Credential:
Phone: 952-445-1352