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
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
03/27/2019
Last updated
10/26/2021
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