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General NPI Number Information
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NPI Number | 1649760257
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Entity Type | Organization
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Legal Business Name | SORENSON PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 5745 S FORT APACHE RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5623
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Country | US
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Telephone | 702-586-4347
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Fax | 702-586-4847
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Provider Business Mailing Address
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Address Line | 5745 S FORT APACHE RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89148-5623
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Country | US
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Telephone | 702-586-4347
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Fax | 702-586-4847
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. LEVI JOHN SORENSON
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Credential | DMD
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Telephone | 702-854-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | S6-131
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License Number State | NV
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