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General NPI Number Information
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NPI Number | 1619791019
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Entity Type | Organization
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Legal Business Name | JAMES R JENSEN, DDS
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 300 1ST AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379-1444
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Country | US
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Telephone | 952-426-0367
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Fax |
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Provider Business Mailing Address
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Address Line | 300 1ST AVE E
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City | SHAKOPEE
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State | MN
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Zip | 55379-1444
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Country | US
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Telephone | 952-426-0367
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TONIA PASS
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Credential |
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Telephone | 952-445-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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