Brent Lee Jorgensen

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DD4795 Issued in NM

Practice address

1508 N Riverside Dr
Espanola, NM 87532-2064

Phone

(888) 988-4066

NPI assigned

Dec 26, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Familia Dental Esp LLC

  • Dental Clinic/Center
  • Espanola, NM
  • NPI 1356634703
  NPD (past)

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

{
    "created_epoch": "1577318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1275172181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD STE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734166",
            "telephone_number": "888-988-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 N RIVERSIDE DR",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322064",
            "telephone_number": "888-988-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "BRENT",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-26",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NM",
            "license": "DD4795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simon M Johnson, BMS
• Carrie Elizabeth Jones, MD
• Jordan E Jones, DO
• Steven D Jones, D.O.
• Marshall C Jordan, MD
• Kimberly Ann Joy, FNP
• Gretchen Kaapcke, LMT
• Sara Lisa Kaminski, MAC,MAT,MSP,NCPM
• Gary Kanner, MD
• Eva Karpinski, RN

• Orthodontics and Dentofacial Orthopedics Dentistry in Espanola, NM
• Providers in Espanola, NM by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; 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.