Individual
MR. SHANE ALLEN JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4114 4TH AVE, KEARNEY, NE 68845-2880
(308) 237-5166
(308) 237-4918
Mailing address
4114 4TH AVE, KEARNEY, NE 68848-3048
(308) 237-5166
(308) 237-4918
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6114
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91-1820685-00
—
NE
Enumeration date
10/17/2006
Last updated
07/08/2007
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