Provider Demographics
NPI:1578621801
Name:SORRELL, MARVIS YVONNE (DMD, MDS)
Entity Type:Individual
Prefix:
First Name:MARVIS
Middle Name:YVONNE
Last Name:SORRELL
Suffix:
Gender:F
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:#202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4020
Mailing Address - Country:US
Mailing Address - Phone:562-597-3639
Mailing Address - Fax:562-597-6236
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:#202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4020
Practice Address - Country:US
Practice Address - Phone:562-597-3639
Practice Address - Fax:562-597-6236
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0317111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics