Provider Demographics
NPI:1033366075
Name:PETRINO, JOSEPH ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:PETRINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3113
Mailing Address - Country:US
Mailing Address - Phone:406-203-2400
Mailing Address - Fax:
Practice Address - Street 1:705 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2117
Practice Address - Country:US
Practice Address - Phone:406-542-1600
Practice Address - Fax:406-542-8945
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24411223E0200X
MND122841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics