Healthcare Provider Details

I. General information

NPI: 1982258778
Provider Name (Legal Business Name): NATHAN JERGENSEN, DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43980 MARGARITA RD STE 101
TEMECULA CA
92592-2783
US

IV. Provider business mailing address

43980 MARGARITA RD STE 101
TEMECULA CA
92592-2783
US

V. Phone/Fax

Practice location:
  • Phone: 951-331-3237
  • Fax:
Mailing address:
  • Phone: 951-331-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANESSA JERGENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-331-3237