Provider Demographics
NPI:1801178561
Name:SORENSEN MORRIS, CRYSTAL WINONA (DDS)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:WINONA
Last Name:SORENSEN MORRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 RAYFORD RD STE 111-336
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1555
Mailing Address - Country:US
Mailing Address - Phone:801-656-8516
Mailing Address - Fax:801-656-8516
Practice Address - Street 1:2211 RAYFORD RD STE 111-336
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1555
Practice Address - Country:US
Practice Address - Phone:801-656-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice