MEDICARE: JAMES E SORGE DMD A PROFESSIONAL CORPORATION

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	261QD0000X	Dental Clinic/Center	45325	CA

General Provider Information

NPI Number	:	1215434451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES E SORGE DMD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1171 PUERTA DEL SOL STE C
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6343
Country	:	US
Telephone Number	:	949-492-3407
Fax Number	:	949-492-1485

Provider Business Practice Location Address
First Line	:	1171 PUERTA DEL SOL STE C
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6343
Country	:	US
Telephone Number	:	949-492-3407
Fax Number	:	949-492-1485

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES EDWARD SORGE
Credential	:	DMD
Telephone Number	:	949-492-3407

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	08/03/2021

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