Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6319 | NV |
NPI | 1043566482 |
---|---|
Provider Name | Dr. Levi Sorenson |
First Address | Las Vegas, NV 89106-4124 |
Second Address | Las Vegas, NV 89106-4124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |