MEDICARE: DR. TIERNEY M PETTINATO DMD

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	1223G0001X	General Practice Dentistry	DN17614	FL

General Provider Information

NPI Number	:	1346303948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIERNEY M PETTINATO DMD

Provider Business Mailing Address
First Line	:	14497 N DALE MABRY HWY STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2047
Country	:	US
Telephone Number	:	954-471-8984
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 VILLAGE MARKET
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-8400
Country	:	US
Telephone Number	:	813-778-3140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/18/2023

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