Shonna Marie Jorgensen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6203-15 Issued in WI

Practice address

540 Village Walk LN
Suite E
Johnson Creek, WI 53038-9554

Phone

(920) 699-2554

Fax

(920) 699-3059

NPI assigned

Dec 5, 2007

Last updated

Dec 5, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Johnson Creek Dental

  • General Practice Dentistry
  • Johnson Creek, WI
  • NPI 1225124571
  NPD (past)

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196812800000",
    "number": "1811179559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 VILLAGE WALK LN",
            "address_2": "SUITE E",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389554",
            "telephone_number": "920-699-2554",
            "fax_number": "920-699-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 VILLAGE WALK LN",
            "address_2": "SUITE E",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389554",
            "telephone_number": "920-699-2554",
            "fax_number": "920-699-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "SHONNA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6203-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnson Creek ASC LLC
• Johnson Creek Counseling & Wellness Center LLC
• Johnson Creek Dental
• Johnson Creek Fire EMS Dept.
• Johnson Creek School District
• Barbara J Kelly, OTR
• Luxottica of America Inc (Oakley B834)
• Thomas M McGorey, MD
• Jonathon J Melk, D.D.S.
• James Milford, MD

• General Practice Dentistry in Johnson Creek, WI
• Providers in Johnson Creek, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; 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.