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General NPI Number Information
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NPI Number | 1275741019
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Entity Type | Individual
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Provider Name | RICHARD EDMUND JENSEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2460 FINGER RD
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City | GREEN BAY
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State | WI
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Zip | 54302-4210
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Country | US
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Telephone | 920-469-8484
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Fax | 920-469-8486
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Provider Business Mailing Address
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Address Line | 2460 FINGER RD
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City | GREEN BAY
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State | WI
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Zip | 54302-4210
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Country | US
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Telephone | 920-469-8484
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Fax | 920-469-8486
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2538
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License Number State | WI
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