Healthcare Provider Details

I. General information

NPI: 1972660454
Provider Name (Legal Business Name): MARK SORIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9159 FRANKTOWN ROAD
FRANKTOWN VA
23354
US

IV. Provider business mailing address

1206 CAPTAIN ADAMS CT
VIRGINIA BEACH VA
23455-4902
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-4819
  • Fax:
Mailing address:
  • Phone: 757-464-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401007304
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: