Healthcare Provider Details

I. General information

NPI: 1437083235
Provider Name (Legal Business Name): KYLE ROBERT JENSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 N ANTIOCH RD
KANSAS CITY MO
64119-2502
US

IV. Provider business mailing address

10224 N WILLOW AVE
KANSAS CITY MO
64157-7711
US

V. Phone/Fax

Practice location:
  • Phone: 816-298-8585
  • Fax:
Mailing address:
  • Phone: 719-663-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026025499
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: