Provider Demographics
NPI:1992907059
Name:JENSEN, REGINA (DDS)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BEE CAVE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2395
Mailing Address - Country:US
Mailing Address - Phone:512-433-6633
Mailing Address - Fax:512-433-6634
Practice Address - Street 1:3801 BEE CAVE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-433-6633
Practice Address - Fax:512-433-6633
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205841223P0221X
CA555071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry