Provider Demographics
NPI:1194715086
Name:SORRENTINO, JOHN (DMD, FAGD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SORRENTINO
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 ROUTE 82
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6165
Mailing Address - Country:US
Mailing Address - Phone:845-226-4100
Mailing Address - Fax:
Practice Address - Street 1:1009 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6165
Practice Address - Country:US
Practice Address - Phone:845-226-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist