Healthcare Provider Details

I. General information

NPI: 1285749168
Provider Name (Legal Business Name): TAL DEAN JERGENSEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43980 MARGARITA RD STE 101
TEMECULA CA
92592-2783
US

IV. Provider business mailing address

27492 TIERRA VERDE DR
HEMET CA
92544-8480
US

V. Phone/Fax

Practice location:
  • Phone: 951-693-9373
  • Fax: 951-699-9337
Mailing address:
  • Phone: 951-306-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number40621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: