Healthcare Provider Details

I. General information

NPI: 1568356236
Provider Name (Legal Business Name): M SORENSEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7888 LA MESA BLVD
LA MESA CA
91942-0633
US

IV. Provider business mailing address

7888 LA MESA BLVD
LA MESA CA
91942-0633
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-8211
  • Fax:
Mailing address:
  • Phone: 619-460-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MCKENZIE SORENSEN
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 619-460-8211