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General NPI Number Information
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NPI Number | 1003903683
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Entity Type | Organization
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Legal Business Name | THOMAS P. PETRICK DMD AND THEODORE J. KATZ DDS, PC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 157 GOOSE LN
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City | GUILFORD
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State | CT
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Zip | 06437-2100
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Country | US
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Telephone | 203-453-4475
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Fax | 203-453-3314
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Provider Business Mailing Address
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Address Line | 157 GOOSE LN
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City | GUILFORD
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State | CT
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Zip | 06437-2100
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Country | US
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Telephone | 203-453-4475
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Fax | 203-453-3314
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Authorized Official
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Title or Position | INSURANCE CO-ORDINATOR
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Name | MRS. WENDY JEAN HACKETT
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Credential | RDH
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Telephone | 203-453-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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