Healthcare Provider Details

I. General information

NPI: 1801044334
Provider Name (Legal Business Name): CHRISTOPHER ALAN PETRUSH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GREGORY LN SUITE #100
PLEASANT HILL CA
94523-3399
US

IV. Provider business mailing address

140 GREGORY LN SUITE #100
PLEASANT HILL CA
94523-3399
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-5515
  • Fax:
Mailing address:
  • Phone: 925-676-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: