Provider Demographics
NPI:1215256698
Name:JENSEN, BETHANY JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:JEAN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:JEAN
Other - Last Name:HIRST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1839 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6505
Mailing Address - Country:US
Mailing Address - Phone:701-839-1299
Mailing Address - Fax:701-839-0015
Practice Address - Street 1:1839 S BROADWAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6505
Practice Address - Country:US
Practice Address - Phone:701-839-1299
Practice Address - Fax:701-839-0015
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice