Provider Demographics
NPI:1215535810
Name:NORVELL FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:NORVELL FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NORVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-549-0374
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0547
Mailing Address - Country:US
Mailing Address - Phone:606-549-0374
Mailing Address - Fax:
Practice Address - Street 1:821 W. HWY 25W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-549-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100376830Medicaid