Organization
JASON SORENSEN D.D.S. A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON SORENSEN D.D.S. (PRESIDENT)
(559) 447-0544
Entity
Organization
Contact information
Practice address
1480 W HERNDON AVE, FRESNO, CA 93711-0552
(559) 447-0544
(559) 431-1827
Mailing address
1480 W HERNDON AVE, FRESNO, CA 93711-0552
(559) 447-0544
(559) 431-1827
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
46690
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9286601
DENTI-CAL PROVIDER ID
CA
Enumeration date
04/20/2007
Last updated
12/08/2009
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