MEDICARE: PATRICIA M. PETROFF D.M.D.

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	19359	MA

General Provider Information

NPI Number	:	1366557936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA M. PETROFF D.M.D.

Provider Business Mailing Address
First Line	:	1255 OAK KNOLL DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2229
Country	:	US
Telephone Number	:	330-668-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 S ARLINGTON RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-4702
Country	:	US
Telephone Number	:	330-644-8423
Fax Number	:	330-644-0884

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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