Provider Demographics
NPI:1972024552
Name:JENSON, ERIK (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:JENSON
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 1:6202 NE HIGHWAY 99 STE 5
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8747
Mailing Address - Country:US
Mailing Address - Phone:360-693-2592
Mailing Address - Fax:
Practice Address - Street 1:6202 NE HIGHWAY 99 STE 5
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8747
Practice Address - Country:US
Practice Address - Phone:360-693-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD106871223G0001X
WADE614669941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice