Provider Demographics
NPI:1598228132
Name:PANELLI, JOE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:J
Last Name:PANELLI
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 1:2824 N POWER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1673
Mailing Address - Country:US
Mailing Address - Phone:480-641-4567
Mailing Address - Fax:480-807-9982
Practice Address - Street 1:2824 N POWER RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1673
Practice Address - Country:US
Practice Address - Phone:480-641-4567
Practice Address - Fax:480-807-9982
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD43591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD4359OtherLICENSE NUMBER