Peder J Jensen, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2544 Issued in AR

Practice address

2501 Crestwood Rd Ste 102
North Little Rock, AR 72116-7615

Phone

(501) 758-6182

Fax

(501) 758-6184

NPI assigned

Jan 16, 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 AR

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

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407907165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 CRESTWOOD RD STE 102",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167615",
            "telephone_number": "501-758-6182",
            "fax_number": "501-758-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 CRESTWOOD RD STE 102",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167615",
            "telephone_number": "501-758-6182",
            "fax_number": "501-758-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "PEDER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AR",
            "license": "2544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS DENTAL LICENSE",
            "identifier": "2544",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Jenkins, LMSW, LADAC
• Carole Frances Jennings
• Claudette L Jennings
• Jamie L Jensen, PLMSW
• Kristi Jensen
• Anusha Jillella, MD
• JM Mobility, LLC
• JM Mobility, LLC
• Joe Lee Buford MD PA
• John Ashley Drive Operating LLC

• Periodontics in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Periodontics in Arkansas

• 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.
• 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.