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General NPI Number Information
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NPI Number | 1073719274
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Entity Type | Organization
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Legal Business Name | RICARDO AND MARIA PELLEGRINI DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14435 HAMLIN ST SUITE # 210
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City | VAN NUYS
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State | CA
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Zip | 91401-6205
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Country | US
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Telephone | 818-908-4090
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Fax | 818-908-4023
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Provider Business Mailing Address
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Address Line | 14435 HAMLIN ST SUITE # 210
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City | VAN NUYS
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State | CA
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Zip | 91401-6205
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Country | US
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Telephone | 818-908-4090
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Fax | 818-908-4023
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICARDO ANGEL PELLEGRINI
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Credential | DDS
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Telephone | 818-908-4090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 51128
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License Number State | CA
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