Organization
M SORENSEN DDS INC
Active
Other names
Red Tail Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MCKENZIE SORENSEN DDS (DENTIST/PRESIDENT)
(619) 460-8211
Entity
Organization
Contact information
Practice address
7888 LA MESA BLVD, LA MESA, CA 91942-0633
(619) 460-8211
Mailing address
7888 LA MESA BLVD, LA MESA, CA 91942-0633
(619) 460-8211
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558846824
NPI
—
Enumeration date
06/05/2025
Last updated
06/05/2025
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