Provider Demographics
NPI:1134912108
Name:JASON A PELLEGRINO DMD PC
Entity type:Organization
Organization Name:JASON A PELLEGRINO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:5920 HAMILTON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-8942
Mailing Address - Country:US
Mailing Address - Phone:610-530-7901
Mailing Address - Fax:610-530-7905
Practice Address - Street 1:5920 HAMILTON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-8942
Practice Address - Country:US
Practice Address - Phone:610-530-7901
Practice Address - Fax:610-530-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty