Provider Demographics
NPI:1518001726
Name:JORGENSON, JAY CHRISTOPHER (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CHRISTOPHER
Last Name:JORGENSON
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PLEASANT AVE S
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1428
Mailing Address - Country:US
Mailing Address - Phone:218-237-7200
Mailing Address - Fax:218-237-7201
Practice Address - Street 1:406 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1428
Practice Address - Country:US
Practice Address - Phone:218-237-7200
Practice Address - Fax:218-237-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist