Provider Demographics
NPI:1639167828
Name:PELLERANO, DANIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIA
Middle Name:A
Last Name:PELLERANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 OSUNA RD NE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111
Mailing Address - Country:US
Mailing Address - Phone:505-292-8515
Mailing Address - Fax:505-292-1785
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 5B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-292-8515
Practice Address - Fax:505-292-1785
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD26781223G0001X
NY0508391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice