Organization
MARK G. PELLETIER, DDS, PA
Active
Other names
Premier Aesthetic Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK G. PELLETIER D.D.S. (PRESIDENT/DENTIST)
(803) 781-7901
Entity
Organization
Contact information
Practice address
900 LAKE MURRAY BLVD, 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
3232
SC
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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