Healthcare Provider Details

I. General information

NPI: 1598605982
Provider Name (Legal Business Name): ERIN M PETRIK DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 W FULLERTON AVE
CHICAGO IL
60647-2484
US

IV. Provider business mailing address

2423 W FULLERTON AVE
CHICAGO IL
60647-2484
US

V. Phone/Fax

Practice location:
  • Phone: 612-290-1434
  • Fax:
Mailing address:
  • Phone: 773-466-2440
  • Fax: 773-466-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN PETRIK
Title or Position: OWNER, MANAGING MEMBER
Credential: DDS
Phone: 612-290-1434