Jensen, Richard Edmund

Jensen, Richard Edmund is an individual health care provider with primary practice located at 2460 Finger Rd , Green Bay WI 54302-4210. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Jensen, Richard Edmund can be contacted via phone (920) 469-8484.

Contact Information

Primary practice address
2460 Finger Rd Green Bay WI 54302-4210
Fax: (920) 469-8486
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2538 Wisconsin

Profile Details

NPI number 1275741019
LBN Legal business name Jensen, Richard Edmund
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2007
Last updated Jul 9th, 2007 - about 15 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 1275741019 NPPES
Wisconsin MEDICAID 33421000

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