Healthcare Provider Details

I. General information

NPI: 1285243733
Provider Name (Legal Business Name): GRANT R. SORENSEN, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 3RD AVE STE 1
WORTHINGTON MN
56187-2399
US

IV. Provider business mailing address

1029 3RD AVE STE 1
WORTHINGTON MN
56187-2399
US

V. Phone/Fax

Practice location:
  • Phone: 507-376-9797
  • Fax:
Mailing address:
  • Phone: 507-376-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: GRANT R SORENSEN
Title or Position: DENTIST
Credential: DDS
Phone: 507-376-9797