Individual
DR. BRAD E SORENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
140 E MAIN STREET, OTHELLO, WA 99344
(509) 488-5256
(509) 488-9939
Mailing address
140 E MAIN STREET, OTHELLO, WA 99344
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00010850
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0218526
WA STATE D L&I #
WA
Enumeration date
03/30/2007
Last updated
07/08/2007
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