MEDICARE: FRANK T. PETRUZZELLO, D.D.S., P.C.

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	2901017505	MI

General Provider Information

NPI Number	:	1669438818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK T. PETRUZZELLO, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	8202 IRVING RD
Second Line	:	SUITE 300
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-4614
Country	:	US
Telephone Number	:	586-978-3900
Fax Number	:	586-978-0214

Provider Business Practice Location Address
First Line	:	8202 IRVING RD
Second Line	:	SUITE 300
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-4614
Country	:	US
Telephone Number	:	586-978-3900
Fax Number	:	586-978-0214

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. FRANK T PETRUZZELLO
Credential	:	D.D.S.
Telephone Number	:	586-978-3900

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/22/2020

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