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General NPI Number Information
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NPI Number | 1740406396
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Entity Type | Organization
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Legal Business Name | JEFFREY L SORENSEN DDS
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24418 75TH ST
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City | SALEM
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State | WI
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Zip | 53168-9703
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Country | US
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Telephone | 262-843-2004
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Fax | 262-843-2832
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Provider Business Mailing Address
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Address Line | 24418 75TH ST
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City | SALEM
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State | WI
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Zip | 53168-9703
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Country | US
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Telephone | 262-843-2004
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Fax | 262-843-2832
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Authorized Official
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Title or Position | INSURANCE PROCESSOR
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Name | SHARI PFENNINGER
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Credential |
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Telephone | 262-843-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | WI3640
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License Number State | WI
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