Provider Demographics
NPI:1053387753
Name:MORELL, MICHAEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MORELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 WINDWARD PL NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1073
Mailing Address - Country:US
Mailing Address - Phone:360-271-3221
Mailing Address - Fax:
Practice Address - Street 1:6500 WINDWARD PL NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1073
Practice Address - Country:US
Practice Address - Phone:360-271-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000069001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice