Provider Demographics
NPI:1427137595
Name:ANDERSON, JENS MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JENS
Middle Name:MARTIN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 2ND AVE S
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5873
Mailing Address - Country:US
Mailing Address - Phone:253-852-5155
Mailing Address - Fax:253-852-5159
Practice Address - Street 1:221 2ND AVE S
Practice Address - Street 2:SUITE # 103
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5873
Practice Address - Country:US
Practice Address - Phone:253-852-5155
Practice Address - Fax:253-852-5159
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000033521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice