# JACK D JORGENSEN DMD PS

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Advanced Dental Concepts
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053413591
- **Authorized official:** DR. JACK DENZIL JORGENSEN DMD (PRESIDENT)
- **Authorized official phone:** (360) 892-6555

## Contact information

- **Practice address:** 7107 NE VANCOUVER MALL DR, STE. \#D, VANCOUVER, WA 98661-8178
- **Practice address phone:** (360) 892-6555
- **Practice address fax:** (360) 892-4170
- **Mailing address:** 7107 NE VANCOUVER MALL DR, STE. \#D, VANCOUVER, WA 98661-8178
- **Mailing address phone:** (360) 892-6555
- **Mailing address fax:** (360) 892-4170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DE00009473 | WA | Yes |

## Other

- **Enumeration date:** 09/04/2006
- **Last updated:** 08/22/2020