MEDICARE: MS. HANNAH M JORGENSEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901602579	MI

General Provider Information

NPI Number	:	1063306926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HANNAH M JORGENSEN DDS

Provider Business Mailing Address
First Line	:	14475 ALEXANDER ST
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48154-4555
Country	:	US
Telephone Number	:	567-377-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	35348 VAN DYKE AVE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-3514
Country	:	US
Telephone Number	:	567-377-4539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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