Healthcare Provider Details

I. General information

NPI: 1134057144
Provider Name (Legal Business Name): SIMON GERARD PETRIZZI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ANDERSON HWY
POWHATAN VA
23139-7307
US

IV. Provider business mailing address

11034 CROSSDALE CT
MECHANICSVILLE VA
23116-4837
US

V. Phone/Fax

Practice location:
  • Phone: 804-531-3550
  • Fax:
Mailing address:
  • Phone: 804-803-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberNONE
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: