Healthcare Provider Details

I. General information

NPI: 1619044252
Provider Name (Legal Business Name): DANIEL JENSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CRESTWOOD RD SUITE #3
KAYSVILLE UT
84037
US

IV. Provider business mailing address

47 CRESTWOOD RD STE 5
KAYSVILLE UT
84037-1445
US

V. Phone/Fax

Practice location:
  • Phone: 801-544-4204
  • Fax: 801-546-6140
Mailing address:
  • Phone: 801-546-2439
  • Fax: 801-546-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number322402-9922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number322402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: