Individual
JUSTIN BURTON JERGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1900 PENNSYLVANIA AVE, FAIRFIELD, CA 94533-3690
(707) 422-3884
Mailing address
1107 KENT DR, DAVIS, CA 95616-0934
(415) 407-1827
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
63313
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
26249
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
63313
CA
Other
Enumeration date
03/30/2011
Last updated
02/11/2015
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