Provider Demographics
NPI:1417035965
Name:JORGENSEN, SLOAN KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SLOAN
Middle Name:KENNETH
Last Name:JORGENSEN
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 1:823 E COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4611
Mailing Address - Country:US
Mailing Address - Phone:509-765-7853
Mailing Address - Fax:
Practice Address - Street 1:823 E COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4611
Practice Address - Country:US
Practice Address - Phone:509-765-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000084631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice