| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 24418 75th St, Salem, Wisconsin |
| Authorized Official Name and Position | Courtney Monteith (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408306 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
24418 75th St Salem WI 53168-9703 Ph: () - | 24418 75th St Salem WI 53168-9703 Ph: (262) 843-2004 |
| NPI Number | 1558975177 |
|---|---|
| Provider Enumeration Date | 09/01/2020 |
| Last Update Date | 12/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558975177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Jeffrey L Sorensen Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 24418 75th St, Salem, WI 53168 Phone: 262-843-2004 Fax: 262-843-2832 |