Provider Demographics
NPI:1962506014
Name:PELLEGRINO, CHRISTOPHER M (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:PELLEGRINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DOWNER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1115
Mailing Address - Country:US
Mailing Address - Phone:781-749-1099
Mailing Address - Fax:781-749-7656
Practice Address - Street 1:20 DOWNER AVE STE 2
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1115
Practice Address - Country:US
Practice Address - Phone:781-749-1099
Practice Address - Fax:781-749-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice