MEDICARE: DR. MARC PARNESS D.D.S.,MS.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0005041	CT

General Provider Information

NPI Number	:	1508015306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC PARNESS D.D.S.,MS.D,

Provider Business Mailing Address
First Line	:	100 MAIN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2506
Country	:	US
Telephone Number	:	860-621-4455
Fax Number	:	860-621-9218

Provider Business Practice Location Address
First Line	:	100 MAIN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2506
Country	:	US
Telephone Number	:	860-621-4455
Fax Number	:	860-621-9218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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