Provider Demographics
NPI:1689749343
Name:JORGENSEN, JENS F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENS
Middle Name:F
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 1:7 E MAITLAND LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1203
Mailing Address - Country:US
Mailing Address - Phone:724-658-2304
Mailing Address - Fax:724-658-5911
Practice Address - Street 1:7 E MAITLAND LANE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1203
Practice Address - Country:US
Practice Address - Phone:724-658-2304
Practice Address - Fax:724-658-5911
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017425L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75662Medicare UPIN
PA047612Medicare ID - Type Unspecified