Provider Demographics
NPI:1588912794
Name:JENSEN, PAIGE BEVEN (RDH, MS)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:BEVEN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 WHISPERING ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-7745
Mailing Address - Country:US
Mailing Address - Phone:505-239-6167
Mailing Address - Fax:
Practice Address - Street 1:543 WHISPERING ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-7745
Practice Address - Country:US
Practice Address - Phone:505-239-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH 2931124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist