Basic Information
| Provider Information | |||||||||
| NPI: | 1962690040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORRELL | ||||||||
| FirstName: | JENTEL | ||||||||
| MiddleName: | OUGRAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2648 MEYER ST | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983278711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048929077 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 525 LILLY RD NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604568844 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2007 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 0401415546 | VA | N | Dental Providers | Dentist | 122300000X | DE61051267 | WA | Y | Dental Providers | Dentist |
No ID Information.