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General NPI Number Information
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NPI Number | 1508939927
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Entity Type | Organization
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Legal Business Name | DAVID S PETRIK DDS PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1760 N FORT HARRISON AVE
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City | CLEARWATER
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State | FL
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Zip | 33755-1706
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Country | US
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Telephone | 727-442-4646
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Fax | 727-442-3542
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Provider Business Mailing Address
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Address Line | 1760 N FORT HARRISON AVE
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City | CLEARWATER
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State | FL
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Zip | 33755-1706
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Country | US
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Telephone | 727-442-4646
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Fax | 727-442-3542
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DAVID S PETRIK
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Credential | DDS
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Telephone | 727-442-4646
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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 | DN 13150
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License Number State | FL
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