Mark Robert Jensen, DDS
Individual provider Active NPI Endodontics · Minnetonka, MN
NPI 1275644684 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1275644684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- 8299 (MN)
- Practice address
- 17705 Hutchins Dr
#207
Minnetonka, MN 55345-4176 - Phone
- (952) 474-6600
- Fax
- (952) 380-0603
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 8299 | MN | Yes |
Addresses
Primary practice location
17705 Hutchins Dr
#207
Minnetonka, MN 55345-4176
Mailing address
17705 Hutchins Dr
#207
Minnetonka, MN 55345-4176
Phone (952) 474-6600
Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.