Provider Demographics
NPI:1417070111
Name:SODERQUIST, KAREN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:SODERQUIST
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 1:3085 W RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286
Mailing Address - Country:US
Mailing Address - Phone:517-423-2135
Mailing Address - Fax:517-423-0009
Practice Address - Street 1:3085 W RUSSELL RD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286
Practice Address - Country:US
Practice Address - Phone:517-423-2135
Practice Address - Fax:517-423-0009
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI181151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice