Healthcare Provider Details

I. General information

NPI: 1093809014
Provider Name (Legal Business Name): STEVEN ALAN JENSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 SHERIDAN DRIVE
BUFFALO NY
14223
US

IV. Provider business mailing address

2156 SHERIDAN DRIVE
BUFFALO NY
14223
US

V. Phone/Fax

Practice location:
  • Phone: 716-871-5488
  • Fax: 716-871-5493
Mailing address:
  • Phone: 716-871-5488
  • Fax: 716-871-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number032583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: