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Organization
RYAN W. JERGENSEN, DDS, PROFESSIONAL CORPORATION
Active
Organization
RYAN W. JERGENSEN, DDS, PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN W. JERGENSEN DDS (PRESIDENT)
(510) 797-8991
Entity
Organization
Contact information
Practice address
2243 MOWRY AVE STE B, FREMONT, CA 94538-1630
(510) 797-8991
(510) 797-8280
Mailing address
2243 MOWRY AVE STE B, FREMONT, CA 94538-1630
(510) 797-8991
(510) 797-8280
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
59484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376859124
PERSONAL/TYPE I NPI
CA
Enumeration date
08/06/2011
Last updated
08/06/2011
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