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NPI Code Detail

MEDICARE: STANFORD SORENSEN DMD

MEDICARE: STANFORD SORENSEN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistD12320OR

General Provider Information

NPI Number : 1023956406
Entity Type Code : Individual
Provider Name (Legal Business Name) : STANFORD SORENSEN DMD
Provider Business Mailing Address
First Line : 295 S 10TH ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-4623
Country : US
Telephone Number : 541-269-5353
Fax Number :
Provider Business Practice Location Address
First Line : 295 S 10TH ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-4623
Country : US
Telephone Number : 541-269-5353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2026
Last Update Date : 04/21/2026

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Directions to “ STANFORD SORENSEN DMD” Practice Location

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