Individual
STEWART WAYNE JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
167 E 200 N, STE 1, LOGAN, UT 84321-4049
(435) 752-5451
Mailing address
167 E 200 N STE 1, LOGAN, UT 84321-4049
(435) 752-5451
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
141758-9922
UT
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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