Healthcare Provider Details

I. General information

NPI: 1427555267
Provider Name (Legal Business Name): MATTHEW PARISEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S HIGLEY RD STE 117
GILBERT AZ
85296-4789
US

IV. Provider business mailing address

1355 S HIGLEY RD STE 117
GILBERT AZ
85296-4789
US

V. Phone/Fax

Practice location:
  • Phone: 480-370-6710
  • Fax:
Mailing address:
  • Phone: 480-370-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD010846
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: