# PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912468463
- **Authorized official:** DR. JAMES PARELLI DMD, MD (ORAL SURGEON/OWNER)
- **Authorized official phone:** (704) 289-8819

## Contact information

- **Practice address:** 102 WAXHAW PROFESSIONAL PARK DR STE G, WAXHAW, NC 28173-5024
- **Practice address phone:** (732) 547-9101
- **Mailing address:** 102 WAXHAW PROFESSIONAL PARK DR STE G, WAXHAW, NC 28173-5024
- **Mailing address phone:** (704) 289-8819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/27/2019
- **Last updated:** 10/26/2021