MEDICARE: STEVE ERIC SORENSEN DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6456209-8903	UT

General Provider Information

NPI Number	:	1184815664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE ERIC SORENSEN DDS,MS

Provider Business Mailing Address
First Line	:	4587 CEDAR HILLS DR
Second Line	:
City	:	CEDAR HILLS
State	:	UT
Zip	:	84062-8826
Country	:	US
Telephone Number	:	801-756-2006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4587 CEDAR HILLS DR
Second Line	:
City	:	CEDAR HILLS
State	:	UT
Zip	:	84062-8826
Country	:	US
Telephone Number	:	801-756-2006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/15/2007

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