Provider Demographics
NPI:1306849195
Name:JORGENSEN, BRIDGETT LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGETT
Middle Name:LYNN
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 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
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice