Individual
DR. BRAIDEN DEMAR JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
610 W BROADWAY AVE, JACKSON, WY 83001-8213
(307) 732-2273
Mailing address
PO BOX 71, TETONIA, ID 83452-0071
(208) 399-2723
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1585
WY
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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