Individual
STANFORD SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
295 S 10TH ST, COOS BAY, OR 97420-4623
(541) 269-5353
Mailing address
295 S 10TH ST, COOS BAY, OR 97420-4623
(541) 269-5353
(541) 266-0933
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12320
OR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D12320
STATE LICENSE
OR
Enumeration date
03/24/2026
Last updated
05/14/2026
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