MEDICARE: REGINA JENSEN, DDS, PA

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	1223P0221X	Pediatric Dentistry		TX

General Provider Information

NPI Number	:	1164866851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGINA JENSEN, DDS, PA

Provider Business Mailing Address
First Line	:	3801 BEE CAVE RD
Second Line	:	SUITE 120
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 BEE CAVE RD
Second Line	:	SUITE 120
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6657
Country	:	US
Telephone Number	:	512-454-5911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REGINA JENSEN
Credential	:
Telephone Number	:	512-454-5911

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	04/24/2013

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