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NPI Code Detail

MEDICARE: DAVID S PETRIK DDS PA

MEDICARE: DAVID S PETRIK DDS PA
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
1122300000XDentistDN 13150FL

General Provider Information

NPI Number : 1508939927
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID S PETRIK DDS PA
Provider Business Mailing Address
First Line : 1760 N FORT HARRISON AVE
Second Line :
City : CLEARWATER
State : FL
Zip : 33755-1706
Country : US
Telephone Number : 727-442-4646
Fax Number : 727-442-3542
Provider Business Practice Location Address
First Line : 1760 N FORT HARRISON AVE
Second Line :
City : CLEARWATER
State : FL
Zip : 33755-1706
Country : US
Telephone Number : 727-442-4646
Fax Number : 727-442-3542
Authorized Official
Title or Position : PRESIDENT OF CORPORATION
Name : DAVID S PETRIK
Credential : DDS
Telephone Number : 727-442-4646
Provider Enumeration Date : 11/15/2006
Last Update Date : 08/22/2020

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Directions to “DAVID S PETRIK DDS PA ” Practice Location

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