PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER (NPI# 1912468463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912468463 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE ORAL SURGERY AND DENTAL IMPLANT CENTER |
| Practice Address |
102 Waxhaw Professional Park Dr Ste G Waxhaw NC 28173-5024 |
| Practice Telephone | 7325479101 |
| Mailing Telephone | 7042898819 |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-12-18 |
| Authorized Official Name | DR. JAMES PARELLI (ORAL SURGEON/OWNER) |
| Authorized Official Telephone | 7325479101 |
| Authorized Official Credential | DMD, MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
Ambulatory Health Care Facilities | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Providence Oral Surgery and Dental Implant Center PLLC | 12517 Pine Valley Club Drive, Charlotte, NC 28277 |
| Street Address |
102 WAXHAW PROFESSIONAL PARK DR STE G |
| City | WAXHAW |
| State | NC |
| Zip Code | 28173-5024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033733175 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 1615 Providence Road South, Marvin, NC 28173 | 2020-06-04 |
| 1225507320 | Shane Markey Dds Ms Pllc | Dentist | 8412 New Town Rd Ste A, Waxhaw, NC 28173 | 2018-11-19 |
| 1336631514 | Suganya Nelatoor,d.d.s.,p.l.l.c. | Clinic/Center | 102 E Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2018-06-04 |
| 1184120750 | Restore Healthcare Medical Group | Counselor | 500 Waxhaw Professional Park Drive, Ste 105 F, Waxhaw, NC 28173 | 2018-04-03 |
| 1730690827 | Concrete Roses Consulting | Community/Behavioral Health | 5960 Fairview Road, 323, Charlotte, NC 28173 | 2017-10-17 |
| 1861849523 | Kayla Selena Caldwell | Social Worker | 3908 Rev. H. Morrison Rd., Waxhaw, NC 28173 | 2016-05-23 |
| 1588023782 | Teri Hipp | Counselor | 101-e Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2016-02-16 |
| 1710355508 | Caresmatic Phase 1,inc. | Assisted Living Facility | 520 Pembroke Ln., Waxhaw, NC 28173 | 2015-09-10 |
| 1437564838 | Anna Waddell Schneiderman | Counselor | 104 Waxhaw Professional Park Drive, Waxhaw, NC 28173 | 2014-06-24 |
| 1467892109 | Samantha Weidele Waldman | Counselor | 9929 Rea Rd Ste 201, Waxhaw, NC 28173 | 2013-06-26 |
| Find all providers in zip 28173 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689224495 | Graham H. Wilson, Dds, Pa | Dentist | 7971 Market Street, Wilmington, NC 28411-9383 | 2019-09-13 |
| 1699263137 | John Breeze | Dentist | Duke University Medical Centre, Durham, NC 27710-0001 | 2018-04-30 |
| 1750823746 | Nazir Ahmad Dds V Pa | Dentist | 2500 Blue Ridge Rd Ste 201, Raleigh, NC 27607-7515 | 2016-11-08 |
| 1447600119 | Jason Michael Goldberg | Dentist | 8815 Christenbury Pkwy Ste 40, Concord, NC 28027-0261 | 2016-06-14 |
| 1760839757 | Nazir Ahmad Dds Iv, Pa | Dentist | 3150 Rogers Rd Ste 111, Wake Forest, NC 27587-4196 | 2016-05-19 |
| 1801262530 | Bradley Paul Storrs | Dentist | 6837 Normandy Rd Bldg B, Attn: Charles Bernatovitz, Fort Bragg, NC 28310-0001 | 2015-08-17 |
| 1003296831 | Jesse Eric Ricciuti | Dentist | 10042 Park Cedar Dr Ste B, Charlotte, NC 28210 | 2015-06-07 |
| 1518346105 | Christopher Abernathy | Dentist | 3111 Springbank Ln Ste A, Charlotte, NC 28226 | 2015-05-28 |
| 1255737078 | Platte Valley Oral & Maxillofacial Surgery LLC | Dentist | 416 Valley View Drive, Suite 800, Scottsbluff, NC 69361-1420 | 2014-11-05 |
| 1780080655 | Robert L Stutts IIi Dmd Paii | Dentist | 200 E Wendover Ave Ste B, Greensboro, NC 27401-1227 | 2014-11-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.