Provider Demographics
NPI:1720149883
Name:MORTELLITI, PETER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MORTELLITI
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 1:47 LADDS WAY
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1901
Mailing Address - Country:US
Mailing Address - Phone:617-462-3244
Mailing Address - Fax:
Practice Address - Street 1:1 INTERNATIONAL PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2602
Practice Address - Country:US
Practice Address - Phone:617-330-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN132631223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice