Provider Demographics
NPI:1336258912
Name:PELLEGRINI, RICHARD ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROBERT
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 1:801 N LARKIN
Mailing Address - Street 2:STE 105
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3442
Mailing Address - Country:US
Mailing Address - Phone:815-744-3400
Mailing Address - Fax:815-744-9925
Practice Address - Street 1:801 N LARKIN
Practice Address - Street 2:STE 105
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3442
Practice Address - Country:US
Practice Address - Phone:815-744-3400
Practice Address - Fax:815-744-9925
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice