Richard Edmund Jensen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2538 Issued in WI

Practice address

2460 Finger Rd
Green Bay, WI 54302-4210

Phone

(920) 469-8484

Fax

(920) 469-8486

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bay Dental Associates of Green Bay, Inc.

  • General Practice Dentistry
  • Green Bay, WI
  • NPI 1720198898

  General Practice

  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1275741019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 FINGER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543024210",
            "telephone_number": "920-469-8484",
            "fax_number": "920-469-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 FINGER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543024210",
            "telephone_number": "920-469-8484",
            "fax_number": "920-469-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "RICHARD",
        "middle_name": "EDMUND",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33421000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Jenkins, PA-C
• Nicholas Jenquin
• Benjamin James Jensen, MD
• Jennifer Marie Jensen, AGPC-NP
• Megan M Jensen, LPC
• Robert Edmund Jensen, DPT
• Tanya Jean Jensen, FNP-C
• Mark K Jenson, M.D.
• Matthew Krueger Jenson, MD
• Kristen M Jerabek, APNP

• General Practice Dentistry in Green Bay, WI
• Providers in Green Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.