Provider Demographics
NPI:1013416742
Name:NEXUS DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:NEXUS DENTAL GROUP PLLC
Other - Org Name:PARLEYS CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-808-2061
Mailing Address - Street 1:2725 E PARLEYS WAY STE 150
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1659
Mailing Address - Country:US
Mailing Address - Phone:801-808-2061
Mailing Address - Fax:801-808-2061
Practice Address - Street 1:2725 E PARLEYS WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1667
Practice Address - Country:US
Practice Address - Phone:801-808-2061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80174279922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental