Provider Demographics
NPI:1255661138
Name:HOWARD J. SORENSEN DDS, MS, PC INC.
Entity Type:Organization
Organization Name:HOWARD J. SORENSEN DDS, MS, PC INC.
Other - Org Name:YUMA ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-783-1017
Mailing Address - Street 1:1150 W 24TH ST
Mailing Address - Street 2:STE E
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8368
Mailing Address - Country:US
Mailing Address - Phone:928-783-1017
Mailing Address - Fax:928-783-5291
Practice Address - Street 1:1150 W 24TH ST
Practice Address - Street 2:STE E
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:928-783-1017
Practice Address - Fax:928-783-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty