Organization
SPAVINAWDENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY JOHN NORELL DDS (DENTIST)
(509) 837-3090
Entity
Organization
Contact information
Practice address
2201 E EDISON RD STE 2, 1726 GREGORY AVE. BOX 314, SUNNYSIDE, WA 98944-9214
(509) 837-3090
(509) 837-3414
Mailing address
2201 E EDISON RD STE 2, SUNNYSIDE, WA 98944-9214
(509) 837-3090
(509) 837-3414
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7925
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5052469
—
WA
Enumeration date
05/14/2010
Last updated
05/14/2010
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