Provider Demographics
NPI:1346342904
Name:SORENSEN, SHANNON WILLIAMS (DDS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:WILLIAMS
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2562
Mailing Address - Country:US
Mailing Address - Phone:800-555-1518
Mailing Address - Fax:800-315-0481
Practice Address - Street 1:76 W HARDING AVE
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2562
Practice Address - Country:US
Practice Address - Phone:800-555-1518
Practice Address - Fax:800-315-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14454999211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice