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Organization
PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER
Active
Organization
PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES PARELLI DMD, MD (ORAL SURGEON/OWNER)
(704) 289-8819
Entity
Organization
Contact information
Practice address
102 WAXHAW PROFESSIONAL PARK DR STE G, WAXHAW, NC 28173-5024
(732) 547-9101
Mailing address
102 WAXHAW PROFESSIONAL PARK DR STE G, WAXHAW, NC 28173-5024
(704) 289-8819
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
NULL
Other
Enumeration date
03/27/2019
Last updated
10/26/2021
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