Provider Demographics
NPI:1033451422
Name:SORENSON, ASHLEY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:E
Last Name:SORENSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-2581
Mailing Address - Country:US
Mailing Address - Phone:608-524-4213
Mailing Address - Fax:
Practice Address - Street 1:764 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-2581
Practice Address - Country:US
Practice Address - Phone:608-524-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7109-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist