Provider Demographics
NPI:1871889857
Name:SORENSON, JUSTIN HAROLD (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:HAROLD
Last Name:SORENSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1729
Mailing Address - Country:US
Mailing Address - Phone:502-935-0505
Mailing Address - Fax:484-842-7509
Practice Address - Street 1:513 E LEWIS AND CLARK PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1729
Practice Address - Country:US
Practice Address - Phone:502-935-0505
Practice Address - Fax:484-842-7509
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011688A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice