Healthcare Provider Details

I. General information

NPI: 1801101803
Provider Name (Legal Business Name): SCOTT M JENSEN DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHERRY ST
GREENSBORO NC
27401-1422
US

IV. Provider business mailing address

920 CHERRY STREET
GREENSBORO NC
27401
US

V. Phone/Fax

Practice location:
  • Phone: 336-379-1500
  • Fax: 336-379-8585
Mailing address:
  • Phone: 336-379-1500
  • Fax: 336-379-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5555
License Number StateNC

VIII. Authorized Official

Name: SCOTT M JENSEN
Title or Position: OWNER
Credential: DMD
Phone: 336-379-1500