Provider Demographics
NPI:1083105100
Name:MICHAEL A PETRILLO DMD PC
Entity Type:Organization
Organization Name:MICHAEL A PETRILLO DMD PC
Other - Org Name:LEHIGH VALLEY SMILE DESIGNS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:PETRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-868-7601
Mailing Address - Street 1:2019 INDUSTRIAL DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2160
Mailing Address - Country:US
Mailing Address - Phone:610-868-7601
Mailing Address - Fax:610-867-8128
Practice Address - Street 1:2019 INDUSTRIAL DR UNIT 1
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2160
Practice Address - Country:US
Practice Address - Phone:610-868-7601
Practice Address - Fax:610-867-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0187281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty