Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DE00004661 | WA |
N | 1223P0221X | Pediatric Dentist | DE00004661 | WA |
NPI | 1144208505 |
---|---|
Provider Name | Dr. Russell F Paravecchio |
First Address | Bellevue, WA 98005-4712 |
Second Address | Bellevue, WA 98005-4722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5047774 | (05) | WA |
T86919 | (02) | WA |