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General NPI Number Information
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NPI Number | 1437275039
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Entity Type | Organization
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Legal Business Name | JENSEN & JENSEN DDS PA
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2480 WHITE BEAR AVE N STE 201
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4567
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Country | US
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Telephone | 651-770-3014
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Fax | 651-770-9199
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Provider Business Mailing Address
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Address Line | 2480 WHITE BEAR AVE N STE 201
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City | MAPLEWOOD
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State | MN
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Zip | 55109-4567
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Country | US
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Telephone | 651-770-3014
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Fax | 651-770-9199
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ROBERT L JENSEN
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Credential | DDS
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Telephone | 651-770-3014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D7860
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License Number State | MN
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