MEDICARE: DR. EDOUARD SORKIN DDS

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	1223G0001X	General Practice Dentistry	5157	AZ

General Provider Information

NPI Number	:	1205833639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDOUARD SORKIN DDS

Provider Business Mailing Address
First Line	:	1939 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5652
Country	:	US
Telephone Number	:	928-855-5041
Fax Number	:	928-855-2757

Provider Business Practice Location Address
First Line	:	1939 MCCULLOCH BLVD N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5652
Country	:	US
Telephone Number	:	928-855-5041
Fax Number	:	928-855-2757

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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