=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639380678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREFREE DENTISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 09/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7518 ELBOW BEND SUITE A1
-----------------------------------------------------
City | CAREFREE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-488-9735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2268
-----------------------------------------------------
City | CAREFREE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-488-9735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-PRESIDENT
-----------------------------------------------------
Name | DR. SETH M JORGENSEN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 480-488-9735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------