Provider Demographics
NPI:1285735050
Name:ROBERT J SORLIEN DMD, PC
Entity type:Organization
Organization Name:ROBERT J SORLIEN DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SORLIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:503-556-1565
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-0007
Mailing Address - Country:US
Mailing Address - Phone:503-556-1565
Mailing Address - Fax:503-556-1566
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048
Practice Address - Country:US
Practice Address - Phone:503-556-1565
Practice Address - Fax:503-556-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD58051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty