Provider Demographics
NPI:1295817534
Name:SORKIN, VIVIAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:A
Last Name:SORKIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:A
Other - Last Name:IBRANIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3460 OLD WASHINGTON ROAD
Mailing Address - Street 2:SUITE 301-B
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602
Mailing Address - Country:US
Mailing Address - Phone:301-638-9350
Mailing Address - Fax:301-638-9353
Practice Address - Street 1:7915 MALCOLM ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-856-8888
Practice Address - Fax:301-856-0353
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics