Provider Demographics
NPI:1437577624
Name:W. ALLWYN METHERELL, DDS PROF. DENTAL CORP
Entity type:Organization
Organization Name:W. ALLWYN METHERELL, DDS PROF. DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ALLWYN
Authorized Official - Last Name:METHERELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-345-6382
Mailing Address - Street 1:1046 MANGROVE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3548
Mailing Address - Country:US
Mailing Address - Phone:530-345-6382
Mailing Address - Fax:
Practice Address - Street 1:1046 MANGROVE AVE STE C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3548
Practice Address - Country:US
Practice Address - Phone:530-345-6382
Practice Address - Fax:530-891-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13395261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center