Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 26317 | CA |
NPI | 1003928250 |
---|---|
Provider Name | Dr. Edward Pellis |
First Address | Newport Beach, CA 92660-7721 |
Second Address | Newport Beach, CA 92660-7721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |