Provider Demographics
NPI:1740406396
Name:JEFFREY L SORENSEN DDS
Entity Type:Organization
Organization Name:JEFFREY L SORENSEN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE PROCESSOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:PFENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-843-2004
Mailing Address - Street 1:24418 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9703
Mailing Address - Country:US
Mailing Address - Phone:262-843-2004
Mailing Address - Fax:262-843-2832
Practice Address - Street 1:24418 75TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9703
Practice Address - Country:US
Practice Address - Phone:262-843-2004
Practice Address - Fax:262-843-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI36401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty