Provider Demographics
NPI:1073684338
Name:SORENSEN, CLIFFORD OWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:OWEN
Last Name:SORENSEN
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 1:1063 S 2450 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-7072
Mailing Address - Country:US
Mailing Address - Phone:801-774-9634
Mailing Address - Fax:
Practice Address - Street 1:120 S STATE ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1010
Practice Address - Country:US
Practice Address - Phone:801-773-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1431211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice