Provider Demographics
NPI:1447414362
Name:DAVID J.W. SOROKOLIT DDS
Entity Type:Organization
Organization Name:DAVID J.W. SOROKOLIT DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DAVID J.W. SOROKOLIT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JW
Authorized Official - Last Name:SOROKOLIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-332-9700
Mailing Address - Street 1:1050 5TH AVE STE G
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2903
Mailing Address - Country:US
Mailing Address - Phone:817-332-9700
Mailing Address - Fax:817-332-9768
Practice Address - Street 1:1050 FIFTH AVE SUITE G
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-332-9700
Practice Address - Fax:817-332-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty