Healthcare Provider Details

I. General information

NPI: 1346342904
Provider Name (Legal Business Name): SHANNON WILLIAMS SORENSEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 S INTERSTATE DR STE 300
CEDAR CITY UT
84720-3794
US

IV. Provider business mailing address

76 W HARDING AVE
CEDAR CITY UT
84720-2562
US

V. Phone/Fax

Practice location:
  • Phone: 800-555-1518
  • Fax: 800-315-0481
Mailing address:
  • Phone: 800-555-1518
  • Fax: 800-315-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1445499921
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: