Individual
BRENT LEE JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1508 N RIVERSIDE DR, ESPANOLA, NM 87532-2064
(888) 988-4066
Mailing address
2050 E ALGONQUIN RD STE 610, SCHAUMBURG, IL 60173-4166
(888) 988-4066
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DD4795
NM
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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