Healthcare Provider Details

I. General information

NPI: 1811433550
Provider Name (Legal Business Name): PHILIP F. JIAMACHELLO, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SIMPSON PARK RD
SHELBY NC
28150-4299
US

IV. Provider business mailing address

221 SIMPSON PARK RD
SHELBY NC
28150-4299
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-3366
  • Fax: 704-484-3441
Mailing address:
  • Phone: 704-484-3366
  • Fax: 704-484-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP FREDERIC JIAMACHELLO
Title or Position: PEDIATRIC DENTIST
Credential: D.D.S.
Phone: 704-484-3366