Healthcare Provider Details

I. General information

NPI: 1750679577
Provider Name (Legal Business Name): DR. DAVID J. SORENSEN, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W 600 N
SPANISH FORK UT
84660-1400
US

IV. Provider business mailing address

PO BOX 1118
SPANISH FORK UT
84660-7118
US

V. Phone/Fax

Practice location:
  • Phone: 801-798-7545
  • Fax:
Mailing address:
  • Phone: 801-798-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number133126
License Number StateUT

VIII. Authorized Official

Name: DR. DAVID JAMES SORENSEN
Title or Position: DENTIST/OWNER
Credential:
Phone: 801-798-7545