Individual
MARK G. PELLETIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
900 LAKE MURRAY BLVD, SUITE 200, IRMO, SC 29063-2923
(803) 781-7901
(803) 749-1376
Mailing address
PO BOX 1181, IRMO, SC 29063-1181
(803) 781-7901
(803) 749-1376
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
SC3232
SC
Other
Enumeration date
02/23/2006
Last updated
07/08/2007
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