Provider Demographics
NPI:1013024249
Name:PELLEGRINI, MELISSA HERNANDEZ
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:HERNANDEZ
Last Name:PELLEGRINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9674
Mailing Address - Country:US
Mailing Address - Phone:985-845-2992
Mailing Address - Fax:985-845-2994
Practice Address - Street 1:198 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9674
Practice Address - Country:US
Practice Address - Phone:985-845-2992
Practice Address - Fax:985-845-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice