Provider Demographics
NPI:1437189388
Name:PELHAM, DAVID (DDS,MMSC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PELHAM
Suffix:
Gender:M
Credentials:DDS,MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1218
Mailing Address - Country:US
Mailing Address - Phone:617-281-5838
Mailing Address - Fax:
Practice Address - Street 1:300 GRANITE ST
Practice Address - Street 2:SOUTH SHORE DENTAL GROUP
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-3909
Practice Address - Country:US
Practice Address - Phone:781-843-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics