Individual
DR. RANDY LEE SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
939 BRYDEN AVE, LEWISTON, ID 83501-5057
(208) 746-2668
Mailing address
939 BRYDEN AVE, LEWISTON, ID 83501-5057
(208) 746-2668
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3092
ID
Other
Enumeration date
08/08/2006
Last updated
07/08/2007
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