Healthcare Provider Details

I. General information

NPI: 1528991023
Provider Name (Legal Business Name): MASON LEE JENSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 JACKSON ST
BELLE FOURCHE SD
57717-1716
US

IV. Provider business mailing address

503 JACKSON ST
BELLE FOURCHE SD
57717-1716
US

V. Phone/Fax

Practice location:
  • Phone: 605-892-6347
  • Fax: 605-892-9027
Mailing address:
  • Phone: 605-892-6347
  • Fax: 605-892-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1519
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: