JUSTIN BURTON JERGENSEN

FAIRFIELD, CA
NPI1205125242
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics
(Licence: TX  26249)
Additional Taxonomies122300000X Dentist
(Licence: CA  63313)
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics
(Licence: CA  63313)
Enumeration Date2011-03-30
Last Update Date2015-02-11
Business Address
-- JUSTIN BURTON JERGENSEN DDS, MS
1900 PENNSYLVANIA AVE
FAIRFIELD, CA 94533-3690
Phone number: 707-422-3884
Mailing Address
-- JUSTIN BURTON JERGENSEN DDS, MS
1107 KENT DR
DAVIS, CA 95616-0934
Phone number: 415-407-1827