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General NPI Number Information
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NPI Number | 1144704503
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Entity Type | Organization
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Legal Business Name | SORENSEN & THOMPSON DENTAL LLC
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 2851 S AVENUE B STE 13A
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-783-1017
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 S AVENUE B STE 13A
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-783-1017
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHASE THOMPSON
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Credential | DMD
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Telephone | 928-783-1017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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