Provider Demographics
NPI:1215226717
Name:PETRILLI, ASHLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLIE
Middle Name:
Last Name:PETRILLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 BARRINGTON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5034
Mailing Address - Country:US
Mailing Address - Phone:847-884-0120
Mailing Address - Fax:847-884-0344
Practice Address - Street 1:1585 BARRINGTON RD STE 205
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5034
Practice Address - Country:US
Practice Address - Phone:847-884-0120
Practice Address - Fax:847-884-0344
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190285561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice