Individual
DR. THOMAS LYLE JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
412 EDISON ST, BRUSH, CO 80723-2130
(970) 842-0220
(970) 842-0224
Mailing address
14375 W 30TH PL, GOLDEN, CO 80401-1413
(303) 489-1831
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10-4803
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03953734
—
CO
Enumeration date
04/10/2007
Last updated
07/08/2007
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