Healthcare Provider Details

I. General information

NPI: 1407689854
Provider Name (Legal Business Name): BARRY SORENSON DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 200 N
SALINA UT
84654-1220
US

IV. Provider business mailing address

20 E 200 N
SALINA UT
84654-1220
US

V. Phone/Fax

Practice location:
  • Phone: 435-529-1000
  • Fax: 435-529-7044
Mailing address:
  • Phone: 435-529-1000
  • Fax: 435-529-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BARRY K SORENSON
Title or Position: DENTIST
Credential: DDS
Phone: 435-529-1000