Provider Demographics
NPI:1164507968
Name:JURGENSEN, RONALD ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALLEN
Last Name:JURGENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 PLACENTIA AVE
Mailing Address - Street 2:201
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3308
Mailing Address - Country:US
Mailing Address - Phone:949-646-4868
Mailing Address - Fax:949-631-1645
Practice Address - Street 1:307 PLACENTIA AVE
Practice Address - Street 2:201
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3308
Practice Address - Country:US
Practice Address - Phone:949-646-4868
Practice Address - Fax:949-631-1645
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG29316122300000X
NY35063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist