1770551723 NPI number — DR. THOMAS COOLEY SORENSEN D.D.S.

Table of content: DR. THOMAS COOLEY SORENSEN D.D.S. (NPI 1770551723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770551723 NPI number — DR. THOMAS COOLEY SORENSEN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORENSEN
Provider First Name:
THOMAS
Provider Middle Name:
COOLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770551723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 N 5TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89801-4473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-753-6118
Provider Business Mailing Address Fax Number:
775-738-2731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6095 FASHION BLVD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-7397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-268-4986
Provider Business Practice Location Address Fax Number:
801-268-8817
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  S6-34C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 140796-9922 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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