1154579274 NPI number — PARSHALL DENTAL CLINIC

Table of content: KELSEY CORBELLI APRN, CNP (NPI 1861241911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154579274 NPI number — PARSHALL DENTAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARSHALL DENTAL CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154579274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 S MAIN
Provider Second Line Business Mailing Address:
PO BOX 520
Provider Business Mailing Address City Name:
PARSHALL
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58770-0520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-862-3121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 S MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARSHALL
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58770-0520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-862-3121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ESTVOLD
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
701-862-3121

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41163 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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