MEDICARE: KYLE SORENSEN 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	DEN.00206312	CO

General Provider Information

NPI Number	:	1215720305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SORENSEN DDS

Provider Business Mailing Address
First Line	:	1818 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3253
Country	:	US
Telephone Number	:	970-239-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3253
Country	:	US
Telephone Number	:	970-239-1514
Fax Number	:

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

Provider Enumeration Date	:	05/22/2025
Last Update Date	:	01/09/2026

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Directions to “ KYLE SORENSEN DDS” Practice Location

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