Jay Daniel Jensen, DDS
Individual provider Active NPI Dentist · Deer Park, WA
NPI 1821384827 · NPPES record last updated May 28, 2026
Key facts
- NPI
- 1821384827
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DENT.DE.60637729 (WA)
- Practice address
- 401 S Main St
Deer Park, WA 99006-8238 - Phone
- (509) 444-8200
- NPI assigned
- Jun 28, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220904000072 | WA | Order and Referring Only - Dentist |
5496139719 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60834 | KS | MD | Dentist |
| DENT.DE.60637729 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Association of Spokane | Dentist | Past | Accepting new patients |
| Community Health Association of Spokane | Past | Accepting new patients | |
| Community Health Association of Spokane | Past | Accepting new patients | |
| Community Health Association of Spokane | Past | Accepting new patients | |
| Community Health Association of Spokane | Dentist | Past | Accepting new patients |
| Community Health Association of Spokane | Past | Accepting new patients | |
| Community Health Association of Spokane | Past | Accepting new patients | |
| Community Health Association of Spokane | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DENT.DE.60637729 | WA | Yes |
| Dentist | 122300000X | 60834 | KS | |
| General Practice Dentistry | 1223G0001X | DENT.DE.60637729 | WA |
Addresses
Primary practice location
401 S Main St
Deer Park, WA 99006-8238
Mailing address
611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8200
Other practice location 1
600 Caisson Hill Road
Ft. Riley, KS 66442-5043
Phone (785) 239-1765
Other practice location 2
6004 Capitol Blvd SE Fl 1
Tumwater, WA 98501-8520
Phone (360) 522-9070
Other providers in Deer Park, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.