Organization
CONDAR,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS JORGENSEN DDS (DENTIST)
(303) 489-1831
Entity
Organization
Contact information
Practice address
412 EDISON ST, BRUSH, CO 80723-2130
(970) 842-0220
(970) 842-0224
Mailing address
PO BOX 563, BRUSH, CO 80723-0563
(970) 842-0220
(970) 842-0224
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
104803
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96774738
—
CO
Enumeration date
10/10/2007
Last updated
10/10/2007
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