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General NPI Number Information
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NPI Number | 1326769563
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Entity Type | Individual
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Provider Name | JAKE PARIANI DMD
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Gender | Male
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 42 FOUR SEASONS SHOPPING CTR STE 129
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3100
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Country | US
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Telephone | 314-936-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 9268 ROTT RD
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1927
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Country | US
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Telephone | 314-578-7726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2022026685
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License Number State | MO
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