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General NPI Number Information
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NPI Number | 1285749168
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Entity Type | Individual
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Provider Name | TAL DEAN JERGENSEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 43980 MARGARITA RD STE 101
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City | TEMECULA
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State | CA
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Zip | 92592-2783
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Country | US
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Telephone | 951-693-9373
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Fax | 951-699-9337
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Provider Business Mailing Address
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Address Line | 27492 TIERRA VERDE DR
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City | HEMET
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State | CA
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Zip | 92544-8480
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Country | US
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Telephone | 951-306-0620
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 40621
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License Number State | CA
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