Provider Demographics
NPI:1386383560
Name:SOREL, EMILIE (DMD)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:SOREL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HARRISON AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2744
Mailing Address - Country:US
Mailing Address - Phone:518-772-7525
Mailing Address - Fax:
Practice Address - Street 1:319 LYNNWAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1811
Practice Address - Country:US
Practice Address - Phone:781-599-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist