Provider Demographics
NPI:1154581403
Name:JENSEN, AARON RUSS (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:RUSS
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 E OMAHA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4908
Mailing Address - Country:US
Mailing Address - Phone:415-407-7605
Mailing Address - Fax:
Practice Address - Street 1:1332 W HERNDON AVE
Practice Address - Street 2:STE. 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7118
Practice Address - Country:US
Practice Address - Phone:559-437-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009864122300000X
CA565031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist