Provider Demographics
NPI:1912171117
Name:SORVINO, WILLIAM F
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:SORVINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2517
Mailing Address - Country:US
Mailing Address - Phone:973-586-4444
Mailing Address - Fax:973-586-4455
Practice Address - Street 1:515 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2517
Practice Address - Country:US
Practice Address - Phone:973-586-4444
Practice Address - Fax:973-586-4455
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist