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General NPI Number Information
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NPI Number | 1235158452
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Entity Type | Individual
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Provider Name | AMANDA JORGENSEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 100 SW BROOKSIDE DR
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City | GRIMES
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State | IA
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Zip | 50111
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Country | US
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Telephone | 515-986-3926
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Fax | 515-986-5116
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Provider Business Mailing Address
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Address Line | 1410 SE ROSEWOOD CT
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City | WAUKEE
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State | IA
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Zip | 50263-8350
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Country | US
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Telephone | 515-778-4278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08223
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License Number State | IA
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