Provider Demographics
NPI:1043796428
Name:JORGENSEN, ERIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 S ORCHARD SPRINGS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:332 S ORCHARD SPRINGS DR STE 110
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-6154
Practice Address - Country:US
Practice Address - Phone:719-569-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031785122300000X
CO00204710122300000X
CODEN.002047101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist