Provider Demographics
NPI:1245460088
Name:PETER M. PELLEGRINI, DDS, MS, P.S.
Entity type:Organization
Organization Name:PETER M. PELLEGRINI, DDS, MS, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:PELLEGRINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:425-374-8218
Mailing Address - Street 1:827 128TH ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5321
Mailing Address - Country:US
Mailing Address - Phone:425-374-8218
Mailing Address - Fax:425-374-8457
Practice Address - Street 1:827 128TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5321
Practice Address - Country:US
Practice Address - Phone:425-374-8218
Practice Address - Fax:425-374-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE6000489141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty