Provider Demographics
NPI:1902460033
Name:GREG JORGENSEN, DMD, MS PC
Entity type:Organization
Organization Name:GREG JORGENSEN, DMD, MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-891-9440
Mailing Address - Street 1:1401 BARBARA LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1056
Mailing Address - Country:US
Mailing Address - Phone:505-891-9440
Mailing Address - Fax:505-994-9743
Practice Address - Street 1:1401 BARBARA LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1056
Practice Address - Country:US
Practice Address - Phone:505-891-9440
Practice Address - Fax:505-994-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty