Provider Demographics
NPI:1366422628
Name:SORGE, JAMES EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:SORGE
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 1:1171 PUERTA DEL SOL STE C
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6343
Mailing Address - Country:US
Mailing Address - Phone:949-492-3407
Mailing Address - Fax:
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:760-728-1592
Practice Address - Fax:760-728-2055
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice