Provider Demographics
NPI:1487056057
Name:SVENSON, JORGEN (DMD)
Entity type:Individual
Prefix:
First Name:JORGEN
Middle Name:
Last Name:SVENSON
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 1:2050 W CHESTER PIKE STE 4
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2742
Mailing Address - Country:US
Mailing Address - Phone:610-789-0158
Mailing Address - Fax:610-789-9238
Practice Address - Street 1:2050 W CHESTER PIKE STE 4
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2742
Practice Address - Country:US
Practice Address - Phone:610-789-0158
Practice Address - Fax:610-789-9238
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026283L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice