Organization
JEROLD R SORENSEN DDS A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY R. SORENSEN DDS (PRES)
(559) 447-0544
Entity
Organization
Contact information
Practice address
90 W 500 S, HEBER CITY, UT 84032
(435) 654-1413
Mailing address
90 W 500 S, HEBER CITY, UT 84032
(435) 654-1413
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
20944
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B2094403
DENTICAL#
CA
Enumeration date
04/20/2007
Last updated
10/24/2019
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