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General NPI Number Information
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NPI Number | 1952528671
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Entity Type | Organization
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Legal Business Name | JASON SORENSEN D.D.S. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 1480 W HERNDON AVE
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City | FRESNO
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State | CA
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Zip | 93711-0552
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Country | US
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Telephone | 559-447-0544
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Fax | 559-431-1827
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Provider Business Mailing Address
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Address Line | 1480 W HERNDON AVE
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City | FRESNO
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State | CA
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Zip | 93711-0552
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Country | US
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Telephone | 559-447-0544
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Fax | 559-431-1827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON SORENSEN
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Credential | D.D.S.
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Telephone | 559-447-0544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 46690
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License Number State | CA
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