NPIMap

Organization Active NPI

Jack D Jorgensen DMD PS

Doing business as Advanced Dental Concepts

  • Dental Clinic/Center
  • Vancouver, WA
National Provider Identifier
1053413591
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DE00009473 Issued in WA
Legal business name
JACK D JORGENSEN DMD PS
Doing business as
Advanced Dental Concepts
Practice address
7107 NE Vancouver Mall Dr
Ste. #D
Vancouver, WA 98661-8178
Phone
(360) 892-6555
Fax
(360) 892-4170
NPI assigned
Sep 4, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack Denzil Jorgensen, DMDNPI 1881796324
Title
President
Phone
(360) 892-6555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DE00009473 WA Primary

Addresses

Primary practice location

7107 NE Vancouver Mall Dr
Ste. #D
Vancouver, WA 98661-8178

Mailing address

7107 NE Vancouver Mall Dr
Ste. #D
Vancouver, WA 98661-8178
Phone (360) 892-6555

Other names 1

  • Advanced Dental Concepts Doing business as

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053413591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7107 NE VANCOUVER MALL DR",
            "address_2": "STE. #D",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986618178",
            "telephone_number": "360-892-6555",
            "fax_number": "360-892-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7107 NE VANCOUVER MALL DR",
            "address_2": "STE. #D",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986618178",
            "telephone_number": "360-892-6555",
            "fax_number": "360-892-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK D JORGENSEN DMD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JORGENSEN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "DENZIL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-892-6555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "DE00009473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Concepts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.