Active NPI
Mark Richard Jensen, D.D.S.
- Endodontics
- Plymouth, MN
National Provider Identifier
1013082882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 10652
- Practice address
- 3401 Highway 169 N
Plymouth, MN 55441-2413 - Phone
- (763) 559-0859
- Fax
- (763) 559-4356
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 10652 | MN | Primary |
Addresses
Primary practice location
3401 Highway 169 N
Plymouth, MN 55441-2413
Mailing address
3401 Highway 169 N
Plymouth, MN 55441-2413
Phone (763) 559-0859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10652 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013082882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 HIGHWAY 169 N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412413",
"telephone_number": "763-559-0859",
"fax_number": "763-559-4356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 HIGHWAY 169 N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554412413",
"telephone_number": "763-559-0859",
"fax_number": "763-559-4356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "MARK",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MN",
"license": "10652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.