Provider Demographics
NPI:1669595476
Name:PELLERITE, PAMELA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:PELLERITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 SAWYER DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2975
Mailing Address - Country:US
Mailing Address - Phone:716-731-3141
Mailing Address - Fax:
Practice Address - Street 1:2113 SAWYER DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2975
Practice Address - Country:US
Practice Address - Phone:716-731-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist