Provider Demographics
NPI:1811433550
Name:PHILIP F. JIAMACHELLO, D.D.S.
Entity type:Organization
Organization Name:PHILIP F. JIAMACHELLO, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:JIAMACHELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-484-3366
Mailing Address - Street 1:221 SIMPSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4299
Mailing Address - Country:US
Mailing Address - Phone:704-484-3366
Mailing Address - Fax:704-484-3441
Practice Address - Street 1:221 SIMPSON PARK RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4299
Practice Address - Country:US
Practice Address - Phone:704-484-3366
Practice Address - Fax:704-484-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty