Healthcare Provider Details

I. General information

NPI: 1477287126
Provider Name (Legal Business Name): TAL D. JERGENSEN, DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43980 MARGARITA RD STE 101
TEMECULA CA
92592-2783
US

IV. Provider business mailing address

43980 MARGARITA RD STE 101
TEMECULA CA
92592-2783
US

V. Phone/Fax

Practice location:
  • Phone: 951-693-9373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAL JERGENSEN
Title or Position: OWNER
Credential: DDS
Phone: 951-693-9373