Provider Demographics
NPI:1851422521
Name:JORGENSEN, JAY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
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 1:140 N LURING DR STE A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6841
Mailing Address - Country:US
Mailing Address - Phone:760-323-2771
Mailing Address - Fax:760-327-8863
Practice Address - Street 1:140 N LURING DR STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6841
Practice Address - Country:US
Practice Address - Phone:760-323-2771
Practice Address - Fax:760-327-8863
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice