Active NPI
Michael Dieter Pellegrinon
- General Practice Dentistry
- Norcross, GA
National Provider Identifier
1174674931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN10733
- Practice address
- 6060 McDonough Drive
Suite I
Norcross, GA 30093 - Phone
- (770) 448-3030
- Fax
- (770) 447-4906
- NPI assigned
- Jan 16, 2007
- 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 | DN10733 | GA | Primary |
Addresses
Primary practice location
6060 McDonough Drive
Suite I
Norcross, GA 30093
Mailing address
1650 Oak Brook Drive
Suite 440
Norcross, GA 30093
Phone (770) 446-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160527000949 | GA | Order and Referring Only - Dentist | 6002122843 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN10733 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174674931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 OAK BROOK DRIVE",
"address_2": "SUITE 440",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30093",
"telephone_number": "770-446-8000",
"fax_number": "770-446-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6060 MCDONOUGH DRIVE",
"address_2": "SUITE I",
"city": "NORCROSS",
"state": "GA",
"postal_code": "30093",
"telephone_number": "770-448-3030",
"fax_number": "770-447-4906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELLEGRINON",
"first_name": "MICHAEL",
"middle_name": "DIETER",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN10733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norcross, GA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.