Healthcare Provider Details

I. General information

NPI: 1194663708
Provider Name (Legal Business Name): SORENSEN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 CALIFORNIA AVE SW APT 102
SEATTLE WA
98116-4151
US

IV. Provider business mailing address

4116 CALIFORNIA AVE SW APT 102
SEATTLE WA
98116-4151
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-6089
  • Fax:
Mailing address:
  • Phone: 206-937-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TAYLOR CHISHOLM
Title or Position: OFFICE MANAGER
Credential:
Phone: 206-937-6089