BRENT LEE JORGENSEN

ESPANOLA, NM
NPI1275172181
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223X0400X Dentist Orthodontics and Dentofacial Orthopedics
(Licence: NM  DD4795)
Enumeration Date2019-12-26
Last Update Date2019-12-26
Business Address
BRENT LEE JORGENSEN
1508 N RIVERSIDE DR
ESPANOLA, NM 87532-2064
Phone number: 888-988-4066
Mailing Address
BRENT LEE JORGENSEN
2050 E ALGONQUIN RD STE 610
SCHAUMBURG, IL 60173-4166
Phone number: 888-988-4066