Provider Demographics
NPI:1679635858
Name:SORENSEN, CLIFFORD G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:G
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:PO BOX 139
Mailing Address - Street 2:7458 E. 1ST STREET
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-0139
Mailing Address - Country:US
Mailing Address - Phone:801-643-1812
Mailing Address - Fax:
Practice Address - Street 1:7458 E FIRST ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84317-9803
Practice Address - Country:US
Practice Address - Phone:801-643-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13297999221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice