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1275172181
BRENT LEE JORGENSEN
ESPANOLA, NM
NPI
1275172181
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223X0400X Dentist Orthodontics and Dentofacial Orthopedics
(Licence: NM DD4795)
Enumeration Date
2019-12-26
Last Update Date
2019-12-26
Business Address
BRENT LEE JORGENSEN
1508 N RIVERSIDE DR
ESPANOLA, NM 87532-2064
Phone number: 888-988-4066
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Mailing Address
BRENT LEE JORGENSEN
2050 E ALGONQUIN RD STE 610
SCHAUMBURG, IL 60173-4166
Phone number: 888-988-4066
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