Provider Demographics
NPI:1215200266
Name:PELLE, STEPHEN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:PELLE
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 1:829 ROBERT DEAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:610-269-1831
Mailing Address - Fax:
Practice Address - Street 1:951 ROHRERSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-394-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD5025959L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist