MEDICARE: FRANK C PETTINATO D.D.S., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255064960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK C PETTINATO D.D.S., P.A.

Provider Business Mailing Address
First Line	:	5252 VILLAGE MARKET
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-8400
Country	:	US
Telephone Number	:	813-907-3100
Fax Number	:	813-907-3110

Provider Business Practice Location Address
First Line	:	5252 VILLAGE MARKET
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-8400
Country	:	US
Telephone Number	:	813-907-3100
Fax Number	:	813-907-3110

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANK PETTINATO
Credential	:	DDS
Telephone Number	:	813-470-8212

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	07/08/2022

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