Provider Demographics
NPI:1023240173
Name:PELLEGRINO, RENEE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:PLUTA DENTAL CENTER AT ROCHESTER GENERAL HOSPITAL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-4554
Mailing Address - Fax:
Practice Address - Street 1:1455 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2006
Practice Address - Country:US
Practice Address - Phone:585-922-4103
Practice Address - Fax:585-922-4495
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist