Individual provider Active NPI

David Charles Jensen, DDS

  • Dentist
  • Scottville, MI
National Provider Identifier
1346551116
Registry record updated Feb 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901020185 Issued in MI
Practice address
825 W US Highway 10 31
Scottville, MI 49454-9601
Phone
(616) 887-7398
NPI assigned
Jun 28, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901020185 MI Primary

Addresses

Primary practice location

825 W US Highway 10 31
Scottville, MI 49454-9601

Mailing address

13105 Myers Lake Ave NE
Cedar Springs, MI 49319-9524
Phone (616) 446-0002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20160205002234 MI Order and Referring Only - DentistPractitioner - Dentist 7719281096

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901020185MIMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1346551116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13105 MYERS LAKE AVE NE",
            "city": "CEDAR SPRINGS",
            "state": "MI",
            "postal_code": "493199524",
            "telephone_number": "616-446-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 W US HIGHWAY 10 31",
            "city": "SCOTTVILLE",
            "state": "MI",
            "postal_code": "494549601",
            "telephone_number": "616-887-7398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "DAVID",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-28",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottville, MI

Sources for this page

Verify at the official NPI Registry.