MEDICARE: STEVEN PETRUZZI DDS PLLC

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	1223P0221X	Pediatric Dentistry	D008162	AZ

General Provider Information

NPI Number	:	1730639840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN PETRUZZI DDS PLLC

Provider Business Mailing Address
First Line	:	26922 N 88TH LN
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-3732
Country	:	US
Telephone Number	:	760-218-1638
Fax Number	:

Provider Business Practice Location Address
First Line	:	34406 N 27TH DR STE 106
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-7730
Country	:	US
Telephone Number	:	760-218-1638
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN JAMES PETRUZZI
Credential	:	DDS
Telephone Number	:	760-218-1638

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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