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General NPI Number Information
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NPI Number | 1356667323
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Entity Type | Organization
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Legal Business Name | DENNIS G PETTIT DDS INC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 1762 COMMERCE CENTER BLVD
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City | FAIRBORN
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State | OH
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Zip | 45324-6358
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Country | US
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Telephone | 937-878-8694
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 COMMERCE CENTER BLVD
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City | FAIRBORN
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State | OH
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Zip | 45324-6358
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Country | US
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Telephone | 937-878-8694
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. DENNIS G. PETTIT
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Credential | DDS
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Telephone | 937-878-8694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 30-01-8161
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License Number State | OH
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