Provider Demographics
NPI:1770702896
Name:SORENSEN, DAVID CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
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 1:1111 24TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5019
Mailing Address - Country:US
Mailing Address - Phone:916-448-2161
Mailing Address - Fax:916-448-2182
Practice Address - Street 1:1111 24TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5019
Practice Address - Country:US
Practice Address - Phone:916-448-2161
Practice Address - Fax:916-448-2182
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist