Healthcare Provider Details

I. General information

NPI: 1679634679
Provider Name (Legal Business Name): JOHN JOSEPH PETRINI JR. D.D.S, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CIVIC DR SUITE 320
WALNUT CREEK CA
94596-3895
US

IV. Provider business mailing address

221 SW 155TH ST
BURIEN WA
98166-2511
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-4040
  • Fax:
Mailing address:
  • Phone: 206-242-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number60724749
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: