Provider Demographics
NPI:1487093886
Name:PEDRO, MARIELLE E (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIELLE
Middle Name:E
Last Name:PEDRO
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 1:516 HAWTHORN ST
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3733
Mailing Address - Country:US
Mailing Address - Phone:508-997-6617
Mailing Address - Fax:508-999-7147
Practice Address - Street 1:516 HAWTHORN ST
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3733
Practice Address - Country:US
Practice Address - Phone:508-997-6617
Practice Address - Fax:508-999-7147
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18562751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice