Healthcare Provider Details

I. General information

NPI: 1366431892
Provider Name (Legal Business Name): PAUL E PARRELLA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 W. HWY 89A #C-1
SEDONA AZ
86336
US

IV. Provider business mailing address

1146 W. HWY 89A #C-1
SEDONA AZ
86336
US

V. Phone/Fax

Practice location:
  • Phone: 928-282-3266
  • Fax:
Mailing address:
  • Phone: 928-282-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4565
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: