Provider Demographics
NPI:1720099849
Name:JENSEN, ROBERT L (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 WHITE BEAR AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4567
Mailing Address - Country:US
Mailing Address - Phone:651-770-3014
Mailing Address - Fax:651-770-9199
Practice Address - Street 1:2480 WHITE BEAR AVE N STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-4567
Practice Address - Country:US
Practice Address - Phone:651-770-3014
Practice Address - Fax:651-770-9199
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND78601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics