Active NPI
Mark G. Pelletier, D.D.S.
- General Practice Dentistry
- Irmo, SC
National Provider Identifier
1013983626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- SC3232
- Practice address
- 900 Lake Murray Blvd
Suite 200
Irmo, SC 29063-2923 - Phone
- (803) 781-7901
- Fax
- (803) 749-1376
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | SC3232 | SC | Primary |
Addresses
Primary practice location
900 Lake Murray Blvd
Suite 200
Irmo, SC 29063-2923
Mailing address
PO Box 1181
Irmo, SC 29063-1181
Phone (803) 781-7901
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 |
|---|---|---|---|
| SC3232 | SC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark G. Pelletier, DDS, PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Irmo, SC
- NPI 1174797526
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013983626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1181",
"city": "IRMO",
"state": "SC",
"postal_code": "290631181",
"telephone_number": "803-781-7901",
"fax_number": "803-749-1376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 LAKE MURRAY BLVD",
"address_2": "SUITE 200",
"city": "IRMO",
"state": "SC",
"postal_code": "290632923",
"telephone_number": "803-781-7901",
"fax_number": "803-749-1376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLETIER",
"first_name": "MARK",
"middle_name": "G.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "SC3232",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.