Active NPI
Jeremy Brian Jorgenson, DDS
- Dentist
- Costa Mesa, CA
National Provider Identifier
1013204627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63373
- Practice address
- 3033 Bristol St
Ste Aa
Costa Mesa, CA 92626-3001 - Phone
- (714) 424-9099
- NPI assigned
- Jul 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD3515 | NM | |
| Dentist | 122300000X | 63373 | CA | Primary |
Addresses
Primary practice location
3033 Bristol St
Ste Aa
Costa Mesa, CA 92626-3001
Mailing address
3033 Bristol St
Ste Aa
Costa Mesa, CA 92626-3001
Phone (714) 424-9099
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3515 | NM | MD | General Practice Dentistry |
| 63373 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gaff Dental Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Costa Mesa, CA
- NPI 1013163385
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406592000000",
"number": "1013204627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3033 BRISTOL ST",
"address_2": "STE AA",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926263001",
"telephone_number": "714-424-9099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3033 BRISTOL ST",
"address_2": "STE AA",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926263001",
"telephone_number": "714-424-9099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSON",
"first_name": "JEREMY",
"middle_name": "BRIAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-03",
"last_updated": "2014-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NM",
"license": "DD3515",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.