Provider Demographics
NPI:1073918835
Name:GREG NORELL, DDS
Entity Type:Organization
Organization Name:GREG NORELL, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:NORELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-837-3090
Mailing Address - Street 1:1726 GREGORY AVENUE EXT
Mailing Address - Street 2:PMB 317
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-1660
Mailing Address - Country:US
Mailing Address - Phone:509-837-3090
Mailing Address - Fax:
Practice Address - Street 1:2201 E EDISON RD
Practice Address - Street 2:STE 2
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-9214
Practice Address - Country:US
Practice Address - Phone:509-837-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA79251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty