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General NPI Number Information
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NPI Number | 1255421392
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Entity Type | Organization
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Legal Business Name | JAMES L. PELLETIER, D.D.S.,P.C.
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1533 LAKEVIEW AVE
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City | DRACUT
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State | MA
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Zip | 01826-3324
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Country | US
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Telephone | 978-957-7170
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Fax | 978-957-9170
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Provider Business Mailing Address
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Address Line | 1533 LAKEVIEW AVENUE
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City | DRACUT
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State | MA
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Zip | 01826
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Country | US
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Telephone | 978-957-7170
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Fax | 978-957-9170
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES LIONEL PELLETIER
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Credential | D.D.S.
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Telephone | 978-957-7170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 17028
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License Number State | MA
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