Provider Demographics
NPI:1083697098
Name:PELLEGRINI, MICHAEL ROCCO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROCCO
Last Name:PELLEGRINI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MOORE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2525
Mailing Address - Country:US
Mailing Address - Phone:617-484-1034
Mailing Address - Fax:617-484-1248
Practice Address - Street 1:18 MOORE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2525
Practice Address - Country:US
Practice Address - Phone:617-484-1034
Practice Address - Fax:617-484-1248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11581OtherBCBS PROVIDER ID
MAX11581OtherBCBS PROVIDER ID