Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 15094 | TX |
NPI | 1053483032 |
---|---|
Provider Name | Dr. Christopher Sorokolit |
First Address | Fort Worth, TX 76107-6141 |
Second Address | Fort Worth, TX 76107-6141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |