Individual
DR. RICHARD EDMUND JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2460 FINGER RD, GREEN BAY, WI 54302-4210
(920) 469-8484
(920) 469-8486
Mailing address
2460 FINGER RD, GREEN BAY, WI 54302-4210
(920) 469-8484
(920) 469-8486
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2538
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33421000
—
WI
Enumeration date
05/17/2007
Last updated
07/09/2007
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