Provider Demographics
NPI:1437394087
Name:CHRISTOPHER A. PEDORELLA DMD, PC
Entity Type:Organization
Organization Name:CHRISTOPHER A. PEDORELLA DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEDORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-884-3119
Mailing Address - Street 1:5586 POST RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3454
Mailing Address - Country:US
Mailing Address - Phone:401-884-3110
Mailing Address - Fax:401-885-7258
Practice Address - Street 1:5586 POST RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3454
Practice Address - Country:US
Practice Address - Phone:401-884-3110
Practice Address - Fax:401-885-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty