MEDICARE: CANDACE JENSEN RDH

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	124Q00000X	Dental Hygienist	020.010813	IL

General Provider Information

NPI Number	:	1225888779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE JENSEN RDH

Provider Business Mailing Address
First Line	:	3440 OHIO ST
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60088-3155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 OHIO ST
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60088-3155
Country	:	US
Telephone Number	:	847-688-2100
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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