Organization
LIFETIME DENTAL CARE OF WISCONSIN, S.C.
Active
Parent organization
HEARTLAND DENTAL
Other names
Jeffrey L. Sorensen, DDS
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEARTLAND DENTAL
Authorized official
COURTNEY MONTEITH (CREDENTIALING COORDINATOR)
(217) 540-8306
Entity
Organization
Contact information
Practice address
24418 75TH ST, SALEM, WI 53168-9703
(262) 843-2004
Mailing address
24418 75TH ST, SALEM, WI 53168-9703
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/01/2020
Last updated
12/06/2022
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