Healthcare Provider Details

I. General information

NPI: 1528729076
Provider Name (Legal Business Name): PEABODY DENTAL SPECIALTIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 ANDOVER ST
PEABODY MA
01960-1539
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE STE 300
MARLBOROUGH MA
01752-1900
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-3072
  • Fax:
Mailing address:
  • Phone: 508-872-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TODD PACHELLO
Title or Position: PRESIDENT CHIEF REVENUE OFFICER
Credential:
Phone: 720-475-6482