Provider Demographics
NPI:1740243708
Name:SOROKOLIT, ROBERT MATTHEW (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATTHEW
Last Name:SOROKOLIT
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 1:4545 BELLAIRE DR S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1889
Mailing Address - Country:US
Mailing Address - Phone:817-738-6111
Mailing Address - Fax:817-738-6364
Practice Address - Street 1:4545 BELLAIRE DR S
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1889
Practice Address - Country:US
Practice Address - Phone:817-738-6111
Practice Address - Fax:817-738-6364
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist