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General NPI Number Information
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NPI Number | 1316393390
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Entity Type | Individual
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Provider Name | ERIN MARIE PETRIK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 2530 N CLARK ST APT 203
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City | CHICAGO
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State | IL
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Zip | 60614-4972
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Country | US
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Telephone | 612-290-1434
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Fax |
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Provider Business Mailing Address
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Address Line | 2530 N CLARK ST APT 203
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City | CHICAGO
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State | IL
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Zip | 60614-4972
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Country | US
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Telephone | 612-290-1434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.030602
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License Number State | IL
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