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General NPI Number Information
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NPI Number | 1265532576
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Entity Type | Organization
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Legal Business Name | DENNIS PELON PHD, PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1640 HASLETT RD SUITE 110
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City | HASLETT
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State | MI
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Zip | 48840-8691
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Country | US
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Telephone | 517-339-1686
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Fax | 517-339-3286
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Provider Business Mailing Address
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Address Line | 1640 HASLETT RD SUITE 110
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City | HASLETT
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State | MI
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Zip | 48840-8691
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Country | US
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Telephone | 517-339-1686
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Fax | 517-339-3286
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Authorized Official
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Title or Position | OWNER
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Name | DENNIS PELON
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Credential | PHD
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Telephone | 517-339-1686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301002693
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License Number State | MI
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