Provider Demographics
NPI:1306062906
Name:JENSEN, MARK A (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 N ARGONNE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2179
Mailing Address - Country:US
Mailing Address - Phone:509-928-5444
Mailing Address - Fax:509-928-5404
Practice Address - Street 1:3018 N ARGONNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-2179
Practice Address - Country:US
Practice Address - Phone:509-928-5444
Practice Address - Fax:509-928-5404
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice