Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | DH.001014148 | CO |
Y | 124Q00000X | Dental Hygienist | DH002024148 | CO |
NPI | 1003361346 |
---|---|
Provider Name | Ms. Jessica Jensen |
First Address | Lafayette, CO 80026-7093 |
Second Address | Lafayette, CO 80026-7093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2016 |
Last Update Date | 15/05/2020 |