Healthcare Provider Details

I. General information

NPI: 1851063572
Provider Name (Legal Business Name): GRETEL GISELA PELLEGRINI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WESTCHESTER AVE STE 1
PORT CHESTER NY
10573-2843
US

IV. Provider business mailing address

1 BLUE SLIP APT 19D
BROOKLYN NY
11222-6757
US

V. Phone/Fax

Practice location:
  • Phone: 914-289-0672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12981
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number063371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: