Provider Demographics
NPI:1073719274
Name:RICARDO AND MARIA PELLEGRINI DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:RICARDO AND MARIA PELLEGRINI DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:PELLEGRINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-908-4090
Mailing Address - Street 1:14435 HAMLIN ST
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6205
Mailing Address - Country:US
Mailing Address - Phone:818-908-4090
Mailing Address - Fax:818-908-4023
Practice Address - Street 1:14435 HAMLIN ST
Practice Address - Street 2:SUITE # 210
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-908-4090
Practice Address - Fax:818-908-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51128261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51128OtherDELTA DENTAL