Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4099 | AZ |
NPI | 1003998741 |
---|---|
Provider Name | Dr. Lee John Sorcinelli |
First Address | Glendale, AZ 85308-1260 |
Second Address | Glendale, AZ 85308-1260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |