NPIMap

Organization Active NPI

Mark G. Pelletier, DDS, PA

  • General Practice Dentistry
  • Irmo, SC
National Provider Identifier
1174797526
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3232 Issued in SC
Legal business name
MARK G. PELLETIER, DDS, PA
Practice address
900 Lake Murray Blvd
Irmo, SC 29063-2923
Phone
(803) 781-7901
Fax
(803) 749-1376
NPI assigned
Apr 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark G. Pelletier, D.D.S.NPI 1013983626
Title
President/Dentist
Phone
(803) 781-7901

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3232 SC Primary

Addresses

Primary practice location

900 Lake Murray Blvd
Irmo, SC 29063-2923

Mailing address

PO Box 1181
Irmo, SC 29063-1181
Phone (803) 781-7901

Other names 1

  • Premier Aesthetic Dentistry Other name

National Provider Directory

National Provider Directory

Locations

900 Lake Murray Blvd
Irmo, SC 29063
Phone (803) 781-7901

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1174797526",
    "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",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290632923",
            "telephone_number": "803-781-7901",
            "fax_number": "803-749-1376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK G. PELLETIER, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "PELLETIER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "803-781-7901",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Aesthetic Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.