Provider Demographics
NPI:1316328529
Name:JENSEN, ALLISON (DMD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W HARRIS AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2497
Mailing Address - Country:US
Mailing Address - Phone:708-482-0702
Mailing Address - Fax:
Practice Address - Street 1:11 S. 2ND AVE #11
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:630-377-1200
Practice Address - Fax:630-377-9801
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist