MEDICARE: DR. STEPHANIE JENSEN D.M.D.

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	DN20678	FL

General Provider Information

NPI Number	:	1235543398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE JENSEN D.M.D.

Provider Business Mailing Address
First Line	:	3251 NW FEDERAL HWY
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4457
Country	:	US
Telephone Number	:	772-692-1447
Fax Number	:	772-692-4623

Provider Business Practice Location Address
First Line	:	5905 SE FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7871
Country	:	US
Telephone Number	:	772-283-5360
Fax Number	:	772-692-4623

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

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	02/14/2023

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