Provider Demographics
NPI:1194152280
Name:PELLERANO, PAOLA ALEJANDRA (DMD)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ALEJANDRA
Last Name:PELLERANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COSTANERA RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6522
Mailing Address - Country:US
Mailing Address - Phone:786-897-9896
Mailing Address - Fax:
Practice Address - Street 1:19084 NE 29TH AVE
Practice Address - Street 2:APT 308
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2805
Practice Address - Country:US
Practice Address - Phone:786-897-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN198001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry