Organization
LODI VALLEY GENTLE DENTAL LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENE RICHARD SORENSEN DDS (PARTNERCHIP CO-OWNER)
(608) 592-4398
Entity
Organization
Contact information
Practice address
216 S MAIN ST, LODI, WI 53555-1121
(608) 592-4398
(608) 592-5245
Mailing address
216 S MAIN ST, LODI, WI 53555-1121
(608) 592-4398
(608) 592-5245
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5001592
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33561900
—
WI
Enumeration date
06/01/2007
Last updated
08/22/2020
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