Provider Demographics
NPI:1740616143
Name:PELLOSIE, LINDA ANNETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANNETTE
Last Name:PELLOSIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:ANNETTE
Other - Last Name:HAMANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1064 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2694
Mailing Address - Country:US
Mailing Address - Phone:352-775-4515
Mailing Address - Fax:
Practice Address - Street 1:1064 LAKE SUMTER LNDG
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-2694
Practice Address - Country:US
Practice Address - Phone:352-775-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN202301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice