Robert Pellosie, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN20866 Issued in FL

Practice address

110 Waterman Ave
Mount Dora, FL 32757-9519

Phone

(352) 383-4414

NPI assigned

Aug 11, 2014

Last updated

Apr 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1174932552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WATERMAN AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579519",
            "telephone_number": "352-502-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 WATERMAN AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579519",
            "telephone_number": "352-383-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLOSIE",
        "first_name": "ROBERT",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-11",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.