MEDICARE: DR. BRIDGETT LYNN JORGENSEN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11158	GA

General Provider Information

NPI Number	:	1306849195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGETT LYNN JORGENSEN D.M.D.

Provider Business Mailing Address
First Line	:	4955 ALTON TUCKER BLVD
Second Line	:	SUITE 600
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-6726
Country	:	US
Telephone Number	:	770-932-0992
Fax Number	:	770-932-9248

Provider Business Practice Location Address
First Line	:	4955 ALTON TUCKER BLVD
Second Line	:	SUITE 600
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-6726
Country	:	US
Telephone Number	:	770-932-0992
Fax Number	:	770-932-9248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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