Provider Demographics
NPI:1508885591
Name:SOREL, BERTRAND (DMD, MD)
Entity Type:Individual
Prefix:
First Name:BERTRAND
Middle Name:
Last Name:SOREL
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 SW SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3342
Mailing Address - Country:US
Mailing Address - Phone:772-219-9979
Mailing Address - Fax:772-219-9975
Practice Address - Street 1:1203 SW SUNSET TRL
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3342
Practice Address - Country:US
Practice Address - Phone:772-219-9979
Practice Address - Fax:772-219-9975
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery