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General NPI Number Information
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NPI Number | 1629103494
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Entity Type | Individual
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Provider Name | MARK M PETRYNA DDS
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1348 MATTHEWS TOWNSHIP PKWY SUITE 101
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City | MATTHEWS
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State | NC
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Zip | 28105
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Country | US
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Telephone | 704-847-7799
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Fax | 704-849-7925
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Provider Business Mailing Address
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Address Line | 1348 MATTHEWS TOWNSHIP PARKWAY SUITE 101
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City | MATTHEWS
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State | NC
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Zip | 28105
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Country | US
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Telephone | 704-847-7799
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Fax | 704-849-7925
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | NC6075
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License Number State | NC
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