Healthcare Provider Details

I. General information

NPI: 1740202662
Provider Name (Legal Business Name): FRANK PETRAKOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11695 MARKET STREET
NORTH LIMA OH
44452
US

IV. Provider business mailing address

PO BOX 304 11695 MARKET STREET
NORTH LIMA OH
44452
US

V. Phone/Fax

Practice location:
  • Phone: 330-549-2800
  • Fax: 330-549-2660
Mailing address:
  • Phone: 330-549-2800
  • Fax: 330-549-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20416
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: