Individual
DR. DOUGLAS E. JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5540 S PULASKI RD, CHICAGO, IL 60629-4418
(773) 735-4434
(773) 735-4993
Mailing address
823 LINCOLN LN, LA GRANGE HIGHLANDS, IL 60525-7401
(708) 354-2024
(708) 354-2070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019017135
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10004342
—
IL
Enumeration date
03/10/2006
Last updated
12/16/2014
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