Healthcare Provider Details

I. General information

NPI: 1386699312
Provider Name (Legal Business Name): EDWARD GEORGE PAROBEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 W MAIN ST
AMELIA OH
45102-1737
US

IV. Provider business mailing address

99 W MAIN ST
AMELIA OH
45102-1737
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-4780
  • Fax:
Mailing address:
  • Phone: 513-753-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30014772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: