Jack Denzil Jorgensen, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DE00009473 Issued in WA

Practice address

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

Phone

(360) 892-6555

Fax

(360) 892-4170

NPI assigned

Sep 4, 2006

Last updated

Jul 1, 2016By the provider in NPPES

Sex

Male

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Advanced Dental Sleep Solutions LLC

  • Durable Medical Equipment & Medical Supplies
  • Vancouver, WA
  • NPI 1730625302
  Authorized official Same address or phone
• Jack D Jorgensen DMD PS

  dba Advanced Dental Concepts

  • Dental Clinic/Center
  • Vancouver, WA
  • NPI 1053413591
  Authorized official Same address or phone

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

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1881796324",
    "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": "986618179",
            "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": "SUITE #D",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986618178",
            "telephone_number": "360-892-6555",
            "fax_number": "360-892-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "JACK",
        "middle_name": "DENZIL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00009473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Kimberly Jordan, RN
• Syriana Alyse Jordan
• Wesley Wren Jordan, M.S.JST
• Laura Jordhen, MD
• Amy Jorgensen, PHARMD
• Marta Jorgenson
• Rupam Josan
• Joey Jose Cristobal Jose, APRN
• Joseph J Kim DDS PS
• Joseph Kim Daniel Lee & John Hodges DDS PLLC (Denture Club of Vancouver)

• Dentist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.