MEDICARE: DR. CLAY JOHN JENSEN JR. DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D-3932	ID

General Provider Information

NPI Number	:	1104938489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAY JOHN JENSEN JR. DMD

Provider Business Mailing Address
First Line	:	UNIT 3690
Second Line	:
City	:	APO
State	:	AE
Zip	:	09126-3690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 3690
Second Line	:
City	:	APO
State	:	AE
Zip	:	09126-3690
Country	:	US
Telephone Number	:	314-452-3184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/06/2023

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