Provider Demographics
NPI:1134289820
Name:ALBRECHTSEN, JON L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:L
Last Name:ALBRECHTSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7210
Mailing Address - Country:US
Mailing Address - Phone:801-782-6681
Mailing Address - Fax:801-786-0539
Practice Address - Street 1:2201 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7210
Practice Address - Country:US
Practice Address - Phone:801-782-6681
Practice Address - Fax:801-786-0539
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8290111-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice