MEDICARE: DR. ANDREW THOMAS JORGENSEN DMD

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	00202007	CO

General Provider Information

NPI Number	:	1518307438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW THOMAS JORGENSEN DMD

Provider Business Mailing Address
First Line	:	1475 PINE GROVE RD STE 107
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8851
Country	:	US
Telephone Number	:	970-879-1959
Fax Number	:	970-879-1973

Provider Business Practice Location Address
First Line	:	1475 PINE GROVE RD STE 107
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8851
Country	:	US
Telephone Number	:	970-879-1959
Fax Number	:	970-879-1973

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

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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