Provider Demographics
NPI:1245469493
Name:PELLEGRINI, PETER M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:PELLEGRINI
Suffix:
Gender:M
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 1:827 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
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600489141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics