Active NPI
Alexandra Pericolosi, DMD
- Dentist
- Iron Mountain, MI
National Provider Identifier
1003478959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2951000663
- Practice address
- 325 E H St
Iron Mountain, MI 49801-4760 - Phone
- (906) 774-3300
- NPI assigned
- Jul 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901600567 | MI | |
| Dentist | 122300000X | 2951000663 | MI | Primary |
Addresses
Primary practice location
325 E H St
Iron Mountain, MI 49801-4760
Mailing address
325 E H St
Iron Mountain, MI 49801-4760
Phone (906) 774-3300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901600567 | MI | MD | Dentist |
| 2951000663 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730073600000",
"number": "1003478959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014760",
"telephone_number": "906-774-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E H ST",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498014760",
"telephone_number": "906-774-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERICOLOSI",
"first_name": "ALEXANDRA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-01",
"last_updated": "2024-10-28",
"certification_date": "2024-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901600567",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2951000663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.