MEDICARE: ROBERT MATTHEW SOROKOLIT D.D.S.

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	20900	TX

General Provider Information

NPI Number	:	1740243708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MATTHEW SOROKOLIT D.D.S.

Provider Business Mailing Address
First Line	:	4545 BELLAIRE DR S
Second Line	:	SUITE 1
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:	817-738-6111
Fax Number	:	817-738-6364

Provider Business Practice Location Address
First Line	:	4545 BELLAIRE DR S
Second Line	:	SUITE 1
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:	817-738-6111
Fax Number	:	817-738-6364

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/09/2007

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