| Ryan W. Jergensen, Dds, Professional Corporation | |
|
2243 Mowry Ave Ste B Fremont CA 94538-1630 | |
| (510) 797-8991 | |
| (510) 797-8280 |
| Full Name | Ryan W. Jergensen, Dds, Professional Corporation |
|---|---|
| Speciality | Dentist |
| Location | 2243 Mowry Ave Ste B, Fremont, California |
| Authorized Official Name and Position | Ryan W. Jergensen (PRESIDENT) |
| Authorized Official Contact | 5107978991 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ryan W. Jergensen, Dds, Professional Corporation 2243 Mowry Ave Ste B Fremont CA 94538-1630 Ph: (510) 797-8991 | Ryan W. Jergensen, Dds, Professional Corporation 2243 Mowry Ave Ste B Fremont CA 94538-1630 Ph: (510) 797-8991 |
| NPI Number | 1649559758 |
|---|---|
| Provider Enumeration Date | 08/06/2011 |
| Last Update Date | 08/06/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649559758 | NPI | - | NPPES |
| 1376859124 | Other | CA | PERSONAL/TYPE I NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 59484 (California) | Primary |
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