Provider Demographics
NPI:1245749209
Name:PETRARCA, GINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:PETRARCA
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 1:1036 ROYAL SAINT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2311
Mailing Address - Country:US
Mailing Address - Phone:630-346-2960
Mailing Address - Fax:
Practice Address - Street 1:878 EASTLAKE PKWY STE 1151
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4546
Practice Address - Country:US
Practice Address - Phone:619-739-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist