Provider Demographics
NPI:1780760918
Name:SORENSON, DALE ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ANTHONY
Last Name:SORENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:LEE
Other - Last Name:WETZEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE COORDINATOR
Mailing Address - Street 1:8166 ROBIN HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3086
Mailing Address - Country:US
Mailing Address - Phone:812-853-0853
Mailing Address - Fax:812-853-0854
Practice Address - Street 1:8166 ROBIN HILL ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3086
Practice Address - Country:US
Practice Address - Phone:812-853-0853
Practice Address - Fax:812-853-0854
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008038A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice