Provider Demographics
NPI:1114953460
Name:PELAGIO, ERLINDA (DMD)
Entity Type:Individual
Prefix:
First Name:ERLINDA
Middle Name:
Last Name:PELAGIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W BENJAMIN HOLT DR
Mailing Address - Street 2:BUILDING B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3839
Mailing Address - Country:US
Mailing Address - Phone:209-476-4700
Mailing Address - Fax:209-478-6890
Practice Address - Street 1:86-078 FARRINGTON HWY
Practice Address - Street 2:SUUITE 210
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3014
Practice Address - Country:US
Practice Address - Phone:808-697-1310
Practice Address - Fax:808-696-1351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice