Provider Demographics
NPI:1326769563
Name:PARIANI, JAKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:PARIANI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9268 ROTT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1927
Mailing Address - Country:US
Mailing Address - Phone:314-578-7726
Mailing Address - Fax:
Practice Address - Street 1:42 FOUR SEASONS SHOPPING CTR STE 129
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3100
Practice Address - Country:US
Practice Address - Phone:314-936-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022026685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist