Provider Demographics
NPI:1215930961
Name:JORGENSEN, G. TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:TODD
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 1:2991 TREAT BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3604
Mailing Address - Country:US
Mailing Address - Phone:925-689-6860
Mailing Address - Fax:925-689-0761
Practice Address - Street 1:2991 TREAT BLVD
Practice Address - Street 2:STE A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3604
Practice Address - Country:US
Practice Address - Phone:925-689-6860
Practice Address - Fax:925-689-0761
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice