Provider Demographics
NPI:1003998741
Name:SORCINELLI, LEE JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:JOHN
Last Name:SORCINELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:SUITE 128
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-978-3643
Mailing Address - Fax:602-938-2283
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-978-3643
Practice Address - Fax:602-938-2283
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist