MEDICARE: DR. ROBERT JOSEPH PACELLA 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	122300000X	Dentist	2901600588	MI

General Provider Information

NPI Number	:	1740806363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOSEPH PACELLA DMD

Provider Business Mailing Address
First Line	:	9260 W LAKE CITY RD
Second Line	:
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-8902
Country	:	US
Telephone Number	:	989-422-4099
Fax Number	:

Provider Business Practice Location Address
First Line	:	9260 W LAKE CITY RD
Second Line	:
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-8902
Country	:	US
Telephone Number	:	989-422-4099
Fax Number	:

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

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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