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Deactivated NPI 1366617953 Deactivated / Inactive NPI Male Practitioner

Dr. Brian Clark Jensen , DMD

Dentist - General Practice • Eagle, ID

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Brian Jensen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 24, 2008
NPI Deactivation Date April 30, 2026
Total Practice Duration ~18 Years of Practice (2008 – 2026)

Professional Overview & Biography Verified Profile Summary

Dr. Brian Jensen, DMD was a registered Dentist - General Practice practicing in Eagle, ID. Throughout an active medical career spanning 18 years, Dr. Jensen provided care at the practice location at 1177 N EAGLE RD until profile deactivation on 2026-04-30.

Practice Location & Contact Primary Location

Practice Address

1177 N Eagle Rd

Eagle, ID 836165017

Telephone 2089393010
Associated Practice Facility / Clinic
🏢 Lighthouse Dental Group Facility NPI 1174631287

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Eagle, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 28.3 Yrs
Regional Practice Density
17 Specialists

Practicing in Eagle, ID (781 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License ID D-3878

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Dr. Michael Higginson , DDS

Dentist - General Practice

NPI 1912172503

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 30, 2026

Record deactivated on April 30, 2026

NPI Profile Active April 24, 2008

NPI status registered as active in NPPES database

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Updated Practice Location April 24, 2008

Registered at 1177 N EAGLE RD, EAGLE, ID 836165017 (Tel: 2089393010)

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Updated Business Mailing Address April 24, 2008

Registered at 1177 N EAGLE RD, EAGLE, ID 836165017 (Tel: 2089393010)

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Provider Name / Credentials Updated April 24, 2008

Recorded as BRIAN JENSEN, D.M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 24, 2008

Dentist (License #D-3878 in ID)

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Initial NPI Registration & Enumeration April 24, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1366617953
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 24, 2008
Last Update: April 24, 2008
Deactivation Date: April 30, 2026

Mailing Address

1177 N Eagle Rd

Eagle, ID 836165017

Phone: 2089393010

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.