Healthcare Provider Details

I. General information

NPI: 1689749343
Provider Name (Legal Business Name): JENS F JORGENSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 E MAITLAND LANE
NEW CASTLE PA
16105-1203
US

IV. Provider business mailing address

7 E MAITLAND LN
NEW CASTLE PA
16105-1203
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-2304
  • Fax: 724-658-5911
Mailing address:
  • Phone: 724-658-2304
  • Fax: 724-658-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS017425L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: