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Individual

DR. PHLLIP M. JENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
2606 MARKETPLACE DR, SPRINGFIELD, IL 62702-1467
(217) 753-8690
Mailing address
2606 MARKETPLACE DR, SPRINGFIELD, IL 62702-1467
(217) 753-8690

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019-020843
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
019020843
IL
01
033519
HEALTH ALLIANCE
IL
01
31898 33225
BCBS
IL
01
442331
UNITED CONCORDIA
IL
Enumeration date
03/22/2007
Last updated
03/21/2012
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