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General NPI Number Information
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NPI Number | 1437566577
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Entity Type | Organization
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Legal Business Name | ANTHONY R. PETRONE, DMD, P.A.
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 1185 LANE AVE S SUITE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6285
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Country | US
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Telephone | 904-783-1422
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Fax | 904-781-7883
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Provider Business Mailing Address
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Address Line | 1185 LANE AVE S SUITE 6
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6285
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Country | US
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Telephone | 904-783-1422
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Fax | 904-781-7883
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY ROBERT PETRONE
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Credential | D.M.D.
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Telephone | 904-783-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19821
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License Number State | FL
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