| Spavinawdental | |
|
2201 E Edison Rd Ste 2 1726 Gregory Ave. Box 314 Sunnyside WA 98944-9214 | |
| (509) 837-3090 | |
| (509) 837-3414 |
| Full Name | Spavinawdental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2201 E Edison Rd Ste 2, Sunnyside, Washington |
| Authorized Official Name and Position | Gregory John Norell (DENTIST) |
| Authorized Official Contact | 5098373090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spavinawdental 2201 E Edison Rd Ste 2 Sunnyside WA 98944-9214 Ph: (509) 837-3090 | Spavinawdental 2201 E Edison Rd Ste 2 1726 Gregory Ave. Box 314 Sunnyside WA 98944-9214 Ph: (509) 837-3090 |
| NPI Number | 1841518859 |
|---|---|
| Provider Enumeration Date | 05/14/2010 |
| Last Update Date | 05/14/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841518859 | NPI | - | NPPES |
| 5052469 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 7925 (Washington) | Primary |
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