Dr. Jaclyn M. Jensen DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12281 Issued in MN

Legal business name

DR. JACLYN M. JENSEN DDS, PC

Practice address

310 S Broadway
Crookston, MN 56716-1913

Phone

(218) 281-1301

NPI assigned

Sep 17, 2008

Last updated

Sep 17, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jaclyn Jensen

Title

Owner

Phone

(218) 281-1301

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1063661726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S BROADWAY",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161913",
            "telephone_number": "218-281-1301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S BROADWAY",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161913",
            "telephone_number": "218-281-1301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JACLYN M. JENSEN DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-17",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-281-1301"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Derosier, LADC
• Vernon Desjarlais
• Bradly Donabauer, DDS
• Ronald C Dorman, MD
• Janelle Lynn Doyle, LICSW
• Anthony Duncan, DO
• Brooke Elde
• Maddie Victoria Engelstad, OTR/L
• Erickson Family Dental P.a.
• Brandi June Erickson

• General Practice Dentistry in Crookston, MN
• Providers in Crookston, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.