National Provider Identifier Database

PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER
Oral and Maxillofacial Surgery

The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.


Contact Information

PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER
102 WAXHAW PROFESSIONAL PARK DR STE G
WAXHAW, NC28173-5024
Phone: 732-547-9101
Fax:
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 1223S0112X
Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER

NPI Number 1912468463
Legal business name
LBN
PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER
Authorized official JAMES PARELLI - (ORAL SURGEON/OWNER)
Entity Organization
Organization subpart No
Enumeration date 03/27/2019
Last updated 10/26/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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