Healthcare Provider Details

I. General information

NPI: 1063322154
Provider Name (Legal Business Name): SORENESEN EDC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ORIENTA AVE STE 1071
ALTAMONTE SPRINGS FL
32701-6608
US

IV. Provider business mailing address

PO BOX 1740
BELLEVUE NE
68005-1740
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-0071
  • Fax:
Mailing address:
  • Phone: 402-658-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID SORENSEN
Title or Position: OWNER
Credential: DDS
Phone: 904-755-1966