Provider Demographics
NPI:1093899593
Name:SORENSEN, DONALD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1508 E SKYLINE DR
Mailing Address - Street 2:DONALD W SORENSEN DDS SUITE 500
Mailing Address - City:SO OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-393-2217
Mailing Address - Fax:801-393-2217
Practice Address - Street 1:1508 E SKYLINE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SO OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-393-2217
Practice Address - Fax:801-393-2217
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1386099922122300000X
UT1386098903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist