Provider Demographics
NPI:1356501951
Name:SORENSEN, BRIAN L (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1107
Mailing Address - Country:US
Mailing Address - Phone:435-462-2491
Mailing Address - Fax:435-462-3999
Practice Address - Street 1:240 N STATE ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:UT
Practice Address - Zip Code:84647-1107
Practice Address - Country:US
Practice Address - Phone:435-462-2491
Practice Address - Fax:435-462-3999
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70286739922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist