Provider Demographics
NPI:1790857795
Name:SORRELLS, LAVALLE DOYLE JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:LAVALLE
Middle Name:DOYLE
Last Name:SORRELLS
Suffix:JR
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 1:6555 STAGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3813
Mailing Address - Country:US
Mailing Address - Phone:901-372-8959
Mailing Address - Fax:901-372-8959
Practice Address - Street 1:6555 STAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3813
Practice Address - Country:US
Practice Address - Phone:901-372-8959
Practice Address - Fax:901-372-8959
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000003488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist