Provider Demographics
NPI:1225550114
Name:PETRYNA, ELIZABETH ZEKAN (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ZEKAN
Last Name:PETRYNA
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 1:2200 PROVIDENCE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1962
Mailing Address - Country:US
Mailing Address - Phone:704-562-1959
Mailing Address - Fax:
Practice Address - Street 1:2915 COLTSGATE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3883
Practice Address - Country:US
Practice Address - Phone:704-365-6505
Practice Address - Fax:704-365-8584
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist