Provider Demographics
NPI:1043228208
Name:GORRELL, JAMES BRENT (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRENT
Last Name:GORRELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 CUESTA DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3667
Mailing Address - Country:US
Mailing Address - Phone:650-967-1441
Mailing Address - Fax:
Practice Address - Street 1:809 CUESTA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3667
Practice Address - Country:US
Practice Address - Phone:650-967-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice