Travis M. Sorensen, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12396150 Issued in UT

Practice address

625 E 500 S Ste 204
Bountiful, UT 84010-3883

Phone

(801) 298-2242

Fax

(801) 294-9920

NPI assigned

Jan 18, 2011

Last updated

May 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bountiful Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bountiful, UT
  • NPI 1861147100
  Medicare reassignment NPD Authorized official
• Valley Implants Oral Surgery and Endodontics PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Pleasant View, UT
  • NPI 1396627089
  Authorized official Same address or phone
• Dennis L Dedecker DDS PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Layton, UT
  • NPI 1578748190
  NPD (past)
• Layton Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Layton, UT
  • NPI 1770238016
  NPD (past)
• North Valley Endodontics, P.a.

  dba Valley Endodontic Specialty Group

  • Endodontics
  • Phoenix, AZ
  • NPI 1659308641
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748304000000",
    "number": "1679878938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E 500 S STE 204",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840103883",
            "telephone_number": "801-298-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E 500 S STE 204",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840103883",
            "telephone_number": "801-298-2242",
            "fax_number": "801-294-9920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3250 N Campbell Ave",
            "address_2": "Ste 116",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857197311",
            "country_code": "US",
            "telephone_number": "520-917-9112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2185 N Robins Dr Ste 204",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840411192",
            "country_code": "US",
            "telephone_number": "801-335-4546",
            "fax_number": "801-335-4546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SORENSEN",
        "first_name": "TRAVIS",
        "middle_name": "M.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-18",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "9349",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NV",
            "license": "6492",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "12396150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camila Soderholm, RBT
• Knitea Solis
• Stuart Chase Sondrup, D.P.T.
• Mari Sorber, COTA
• Allison Leigh Sorensen
• Misty Sorenson, CSW
• Terra Marie Soto, OTR/L
• South Davis Community Hospital (Orchard Cove)
• South Davis Community Hospital, Inc. (The Inn on Barton Creek)
• South Davis Metro Fire Agency

• Oral and Maxillofacial Surgery (Dentist) in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.