Individual
MICHELE JEHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
37677
CA
1223X2210X
Orofacial Pain Dentistry
37677
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
37677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ23054Z
MEDICARE PTAN
CA
Enumeration date
04/28/2008
Last updated
04/11/2024
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