Provider Demographics
NPI:1174139703
Name:PEJO, ERVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:
Last Name:PEJO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4924
Mailing Address - Country:US
Mailing Address - Phone:857-526-1886
Mailing Address - Fax:
Practice Address - Street 1:824 WILLIAM S CANNING BLVD A
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721
Practice Address - Country:US
Practice Address - Phone:508-730-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18588121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice