Provider Demographics
NPI:1558516971
Name:PELAEZ, ADRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:
Last Name:PELAEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1607
Mailing Address - Country:US
Mailing Address - Phone:626-367-6349
Mailing Address - Fax:
Practice Address - Street 1:410 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1607
Practice Address - Country:US
Practice Address - Phone:626-367-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice