Jensen, Phllip M.

Jensen, Phllip M. is an individual health care provider with primary practice located at 2606 Marketplace Dr , Springfield IL 62702-1467. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Jensen, Phllip M. can be contacted via phone (217) 753-8690.

Contact Information

Primary practice address
2606 Marketplace Dr Springfield IL 62702-1467
Phone: (217) 753-8690
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 019-020843 Illinois

Profile Details

NPI number 1699892042
LBN Legal business name Jensen, Phllip M.
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 22nd, 2007
Last updated Mar 21st, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699892042 NPPES
Illinois MEDICAID 019020843
Illinois Other 033519
Illinois Other 442331
Illinois Other 31898 33225

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