MEDICARE: DAVID PETRIK DDS

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	DN13150	FL

General Provider Information

NPI Number	:	1356759112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PETRIK DDS

Provider Business Mailing Address
First Line	:	5341 GRAND BLVD
Second Line	:	STE 108
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4004
Country	:	US
Telephone Number	:	727-847-6453
Fax Number	:	727-847-6447

Provider Business Practice Location Address
First Line	:	4843 US HIGHWAY 19
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4252
Country	:	US
Telephone Number	:	727-847-6453
Fax Number	:	727-847-6447

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	05/09/2016

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Directions to “ DAVID PETRIK DDS” Practice Location

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