Provider Demographics
NPI:1679896419
Name:JENSEN, WILHELMINA P (DDS)
Entity type:Individual
Prefix:DR
First Name:WILHELMINA
Middle Name:P
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15248 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-5183
Mailing Address - Country:US
Mailing Address - Phone:402-493-5551
Mailing Address - Fax:402-493-5551
Practice Address - Street 1:15248 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-5183
Practice Address - Country:US
Practice Address - Phone:402-493-5551
Practice Address - Fax:402-493-5551
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist