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General NPI Number Information
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NPI Number | 1215239819
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Entity Type | Organization
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Legal Business Name | J. BRENT GORRELL, DDS
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 809 CUESTA DR SUITE 205
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3667
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Country | US
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Telephone | 650-967-1441
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Fax | 650-967-7341
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Provider Business Mailing Address
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Address Line | 809 CUESTA DR SUITE 205
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3667
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Country | US
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Telephone | 650-967-1441
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Fax | 650-967-7341
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAMES BRENT GORRELL
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Credential | D.D.S.
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Telephone | 650-967-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 28559
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License Number State | CA
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