Jensen, Douglas E.

Jensen, Douglas E. is an individual health care provider with primary practice located at 5540 S Pulaski Rd , Chicago IL 60629-4418. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Jensen, Douglas E. can be contacted via phone (773) 735-4434.

Contact Information

Primary practice address
5540 S Pulaski Rd Chicago IL 60629-4418
Phone: (773) 735-4434
Fax: (773) 735-4993
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 019017135 Illinois

Profile Details

NPI number 1124096425
LBN Legal business name Jensen, Douglas E.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 10th, 2006
Last updated Dec 16th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124096425 NPPES
Illinois MEDICAID 10004342

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