Provider Demographics
NPI:1487546685
Name:HUSEBY, JENS (DMD)
Entity type:Individual
Prefix:
First Name:JENS
Middle Name:
Last Name:HUSEBY
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 1:7330 TALL PINES RD NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-7041
Mailing Address - Country:US
Mailing Address - Phone:218-407-0643
Mailing Address - Fax:
Practice Address - Street 1:110 MAG SEVEN CT SW STE 220
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4678
Practice Address - Country:US
Practice Address - Phone:218-333-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND153681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice