Provider Demographics
NPI:1205833639
Name:SORKIN, EDOUARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDOUARD
Middle Name:
Last Name:SORKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:EDOUARD
Other - Middle Name:
Other - Last Name:SORKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1939 MCCULLOCH BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5652
Mailing Address - Country:US
Mailing Address - Phone:928-855-5041
Mailing Address - Fax:928-855-2757
Practice Address - Street 1:1939 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5652
Practice Address - Country:US
Practice Address - Phone:928-855-5041
Practice Address - Fax:928-855-2757
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice