MEDICARE: CHRISTOPHER BRETT 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	1223G0001X	General Practice Dentistry	1680	WY

General Provider Information

NPI Number	:	1447088539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER BRETT JORGENSEN DDS

Provider Business Mailing Address
First Line	:	1709 E INDIAN WELLS LN
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-8899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 PARK RD
Second Line	:
City	:	EVANSTON
State	:	WY
Zip	:	82930-2613
Country	:	US
Telephone Number	:	307-789-5608
Fax Number	:

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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