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General NPI Number Information
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NPI Number | 1477630655
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Entity Type | Individual
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Provider Name | MARY B CORRELL DDS
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6821 N COUNTRY HOMES BLVD SRE.#202
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City | SPOKANE
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State | WA
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Zip | 99208-4372
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Country | US
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Telephone | 509-326-2621
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Fax | 509-325-5796
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Provider Business Mailing Address
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Address Line | 1625 W FRANCIS AVE
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City | SPOKANE
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State | WA
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Zip | 99205-6800
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Country | US
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Telephone | 509-326-2621
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Fax | 509-325-5796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00007564
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License Number State | WA
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