Individual
DR. STEPHEN RAY JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1161 MALL DR STE A, LAS CRUCES, NM 88011-8193
(575) 522-1779
(575) 522-4789
Mailing address
2878 DIAMOND SPRINGS DR, LAS CRUCES, NM 88011-5235
(808) 840-7656
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
52028788903
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DD3479
NM
Other
Enumeration date
04/05/2006
Last updated
06/23/2011
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