Provider Demographics
NPI:1639385156
Name:PELLEGRINI, RICARDO ANGEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANGEL
Last Name:PELLEGRINI
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 1:14435 HAMLIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6205
Mailing Address - Country:US
Mailing Address - Phone:818-908-4090
Mailing Address - Fax:818-908-4023
Practice Address - Street 1:14435 HAMLIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-908-4090
Practice Address - Fax:818-908-4023
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist