Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 009864 | CT |
Y | 1223E0200X | Endodontist | 56503 | CA |
NPI | 1154581403 |
---|---|
Provider Name | Dr. Aaron Russ Jensen |
First Address | Fresno, CA 93720-4908 |
Second Address | Fresno, CA 93711-7118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 24/09/2010 |