Basic Information
| Provider Information | |||||||||
| NPI: | 1073918835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREG NORELL, DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1726 GREGORY AVENUE EXT | ||||||||
| Address2: | PMB 317 | ||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989441660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098373090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2201 E EDISON RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989449214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098373090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2014 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | NORELL | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 5098373090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 7925 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.