MEDICARE: DR. JOE J PANELLI DMD

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	1223G0001X	General Practice Dentistry	D4359	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D4359	OTHER	AZ	LICENSE NUMBER

General Provider Information

NPI Number	:	1598228132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE J PANELLI DMD

Provider Business Mailing Address
First Line	:	2824 N POWER RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1673
Country	:	US
Telephone Number	:	480-641-4567
Fax Number	:	480-807-9982

Provider Business Practice Location Address
First Line	:	2824 N POWER RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-1673
Country	:	US
Telephone Number	:	480-641-4567
Fax Number	:	480-807-9982

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	04/10/2019

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