Healthcare Provider Details

I. General information

NPI: 1093602385
Provider Name (Legal Business Name): NEVIN JENSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 295
CLEVELAND UT
84518-0295
US

IV. Provider business mailing address

PO BOX 295
CLEVELAND UT
84518-0295
US

V. Phone/Fax

Practice location:
  • Phone: 435-749-1782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9336175-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9336175-1701
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012773
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: