Individual
DR. MICHAEL W. JORGENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS,MS,MBA
Contact information
Practice address
7700 W. OLD SHAKOPEE RD., BLOOMINGTON, MN 55438-5788
(952) 288-7437
Mailing address
6020 NORTHWOOD RDG, BLOOMINGTON, MN 55438-1281
(952) 288-7437
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
MN8356
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411381044
FED TAX ID
MN
01
—
5904177
MN TAX ID
MN
Enumeration date
11/16/2006
Last updated
03/17/2011
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