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General NPI Number Information
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NPI Number | 1588672588
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Entity Type | Organization
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Legal Business Name | THOMAS PETNUCH DMD PC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 259 OLD ROUTE 30 SUITE D
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City | GREENSBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-836-6884
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Fax | 724-836-4616
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Provider Business Mailing Address
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Address Line | 259 OLD ROUTE 30 SUITE D
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City | GREENBURG
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State | PA
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Zip | 15601
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Country | US
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Telephone | 724-836-6884
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Fax | 724-836-4616
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. THOMAS PETNUCH
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Credential | DMD
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Telephone | 724-836-6884
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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 | DS021701L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS035001
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License Number State | PA
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