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General NPI Number Information
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NPI Number | 1518358910
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Entity Type | Individual
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Provider Name | NATHAN JERGENSEN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2015
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 550 E LATHAM AVE STE 3
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City | HEMET
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State | CA
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Zip | 92543-4361
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Country | US
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Telephone | 951-331-3237
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Fax | 951-699-9337
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Provider Business Mailing Address
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Address Line | 550 E LATHAM AVE STE 3
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City | HEMET
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State | CA
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Zip | 92543-4361
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Country | US
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Telephone | 951-331-3237
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Fax | 951-766-1412
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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 | 63962
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License Number State | CA
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