Healthcare Provider Details

I. General information

NPI: 1003831009
Provider Name (Legal Business Name): JAMES LIONEL PELLETIER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 LAKEVIEW AVE
DRACUT MA
01826-3324
US

IV. Provider business mailing address

1533 LAKEVIEW AVE
DRACUT MA
01826-3324
US

V. Phone/Fax

Practice location:
  • Phone: 978-957-7170
  • Fax: 978-957-9170
Mailing address:
  • Phone: 978-957-7170
  • Fax: 978-957-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number17028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: