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General NPI Number Information
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NPI Number | 1891076683
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Entity Type | Organization
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Legal Business Name | JOSEPH S.PETREY PLLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 224 LANGDON ST
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City | SOMERSET
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State | KY
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Zip | 42501-2342
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Country | US
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Telephone | 606-451-0771
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Fax | 606-451-0780
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Provider Business Mailing Address
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Address Line | 224 LANGDON ST
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City | SOMERSET
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State | KY
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Zip | 42501-2342
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Country | US
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Telephone | 606-451-0771
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Fax | 606-451-0780
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Authorized Official
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Title or Position | MEMBER /MANAGER
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Name | DR. JOSEPH STANLEY PETREY
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Credential | DMD
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Telephone | 606-451-0771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8298
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License Number State | KY
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