Provider Demographics
NPI:1831250042
Name:SORHUS, JEREMY SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:SCOTT
Last Name:SORHUS
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 1:120 TRADING BAY RD.
Mailing Address - Street 2:#280
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7781
Mailing Address - Country:US
Mailing Address - Phone:907-335-0363
Mailing Address - Fax:907-335-0364
Practice Address - Street 1:120 TRADING BAY RD.
Practice Address - Street 2:#280
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7781
Practice Address - Country:US
Practice Address - Phone:907-335-0363
Practice Address - Fax:907-335-0364
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDEND13801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000021444OtherBLUE CROSS BLUE SHIELD ID
AK1573802Medicaid
MT01620902OtherUNITED CONCORDIA ID