Provider Demographics
NPI:1730255159
Name:JENSEN, BENJAMIN D (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 FOX RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5350
Mailing Address - Country:US
Mailing Address - Phone:605-665-7479
Mailing Address - Fax:605-260-7410
Practice Address - Street 1:2703 FOX RUN PKWY
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5350
Practice Address - Country:US
Practice Address - Phone:605-665-7479
Practice Address - Fax:605-260-7410
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7809990Medicaid
TN4009856OtherBCBS OF TN
NE46046145300Medicaid