Provider Demographics
NPI:1235233768
Name:JORGENSEN, MARTIN FRANCIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:FRANCIS
Last Name:JORGENSEN
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 1:501 SE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7631
Mailing Address - Country:US
Mailing Address - Phone:954-600-5008
Mailing Address - Fax:
Practice Address - Street 1:2722 NE 1ST ST
Practice Address - Street 2:SUITE #1
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4933
Practice Address - Country:US
Practice Address - Phone:954-943-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist