Kurt Fredric Jensen, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Practice address

6050 Brynwood Dr
Ste 102
Rockford, IL 61114-6579

Phone

(815) 877-0694

Fax

(815) 877-4254

NPI assigned

Feb 7, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 11, 2017 through Apr 11, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598805822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 BRYNWOOD DR",
            "address_2": "STE 102",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611146579",
            "telephone_number": "815-877-0694",
            "fax_number": "815-877-4254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 BRYNWOOD DR",
            "address_2": "STE 102",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611146579",
            "telephone_number": "815-877-0694",
            "fax_number": "815-877-4254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "KURT",
        "middle_name": "FREDRIC",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Nichole Jenkins
• Crystal Jewell Jenkins
• Leann Jenkins, MS, LCPC
• Jennie N. Marquez
• Christa Jennings
• David Jeong, MD
• Aimee Michelle Jerding, LSW
• Paulette Jeronimus, LMT
• Jesse Belle Counseling PLLC
• Jet Healthcare LLC

• Oral and Maxillofacial Surgery (Dentist) in Rockford, IL
• Providers in Rockford, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.