Provider Demographics
NPI:1790159341
Name:PELLILLO, SONNI (DDS, MS)
Entity Type:Individual
Prefix:
First Name:SONNI
Middle Name:
Last Name:PELLILLO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6477 CHERRY MEADOW DR SE STE 2
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7351
Mailing Address - Country:US
Mailing Address - Phone:304-612-4242
Mailing Address - Fax:
Practice Address - Street 1:6477 CHERRY MEADOW DR SE STE 2
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7351
Practice Address - Country:US
Practice Address - Phone:304-612-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010225441223X0400X
WV40791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics