MEDICARE: JAY D. JENSEN D.D.S.

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	139107	UT

General Provider Information

NPI Number	:	1598866469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY D. JENSEN D.D.S.

Provider Business Mailing Address
First Line	:	3098 S HIGHLAND DR
Second Line	:	STE 400
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3618
Country	:	US
Telephone Number	:	801-467-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2043 E 2700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1720
Country	:	US
Telephone Number	:	801-467-9111
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	01/17/2016

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