Individual
MR. OLAV JENS SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
621 JENSEN GROVE DR, BLACKFOOT, ID 83221-1685
(208) 915-8419
Mailing address
621 JENSEN GROVE DR, BLACKFOOT, ID 83221-1685
(208) 915-8419
(208) 785-2016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4435
ID
Other
Enumeration date
03/14/2012
Last updated
04/23/2021
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