Provider Demographics
NPI:1003831009
Name:PELLETIER, JAMES LIONEL (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LIONEL
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3324
Mailing Address - Country:US
Mailing Address - Phone:978-957-7170
Mailing Address - Fax:978-957-9170
Practice Address - Street 1:1533 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3324
Practice Address - Country:US
Practice Address - Phone:978-957-7170
Practice Address - Fax:978-957-9170
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics