Healthcare Provider Details

I. General information

NPI: 1336106483
Provider Name (Legal Business Name): DAVID LEIGH PETRICK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: DAVID L PETRICK DMD

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 LINCOLN WAY
WHITE OAK PA
15131
US

IV. Provider business mailing address

1504 LINCOLN WAY
WHITE OAK PA
15131
US

V. Phone/Fax

Practice location:
  • Phone: 412-672-4100
  • Fax: 412-672-7443
Mailing address:
  • Phone: 412-672-4100
  • Fax: 412-672-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS018729L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: