Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 104736 | UT |
NPI | 1821098682 |
---|---|
Provider Name | Dr. Ole T Jensen |
First Address | Greenwood Village, CO 80111-2803 |
Second Address | Greenwood Village, CO 80111-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 13/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
840830469 | (02) | CO |