Provider Demographics
NPI:1184847121
Name:BRIDGETT L JORGENSEN DMD PC
Entity Type:Organization
Organization Name:BRIDGETT L JORGENSEN DMD PC
Other - Org Name:NORTH GWINNETT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-932-0992
Mailing Address - Street 1:4955 ALTON TUCKER BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6726
Mailing Address - Country:US
Mailing Address - Phone:770-932-0992
Mailing Address - Fax:770-932-9248
Practice Address - Street 1:4955 ALTON TUCKER BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-6726
Practice Address - Country:US
Practice Address - Phone:770-932-0992
Practice Address - Fax:770-932-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty