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NPI Code Detail

MEDICARE: DR. RODNEY PETREY

MEDICARE:  DR. RODNEY  PETREY
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
11223G0001XGeneral Practice Dentistry5915KY

General Provider Information

NPI Number : 1720293673
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODNEY PETREY
Provider Business Mailing Address
First Line : 2011 RAMBLER RD
Second Line : SUITE 1
City : LEXINGTON
State : KY
Zip : 40503-2440
Country : US
Telephone Number : 859-277-0011
Fax Number : 859-277-1703
Provider Business Practice Location Address
First Line : 2011 RAMBLER RD
Second Line : SUITE 1
City : LEXINGTON
State : KY
Zip : 40503-2440
Country : US
Telephone Number : 859-277-0011
Fax Number : 859-277-1703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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Directions to “ DR. RODNEY PETREY ” Practice Location

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