Provider Demographics
NPI:1598788333
Name:JORGENSEN, REED E (DDS)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:E
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 1:1260 N 200 E STE 3
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2382
Mailing Address - Country:US
Mailing Address - Phone:435-753-2882
Mailing Address - Fax:435-787-2087
Practice Address - Street 1:1260 N 200 E STE 3
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2382
Practice Address - Country:US
Practice Address - Phone:435-753-2882
Practice Address - Fax:435-787-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice