Provider Demographics
NPI:1316444540
Name:JFS2DMD99PC
Entity type:Organization
Organization Name:JFS2DMD99PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:SORRENTO
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-356-0602
Mailing Address - Street 1:130 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2550
Mailing Address - Country:US
Mailing Address - Phone:978-356-0602
Mailing Address - Fax:978-356-8479
Practice Address - Street 1:130 COUNTY RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2550
Practice Address - Country:US
Practice Address - Phone:978-356-0602
Practice Address - Fax:978-356-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043468714OtherGENERAL DENTIST
MA043468714OtherGENERAL DENTIST