Provider Demographics
NPI:1255316550
Name:PETRICH, ANTON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:PETRICH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 WOOD ROAD
Mailing Address - Street 2:BLDG 1, RM 3521
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5628
Mailing Address - Country:US
Mailing Address - Phone:301-295-1550
Mailing Address - Fax:
Practice Address - Street 1:8955 WOOD ROAD
Practice Address - Street 2:BUILDING 1, RM 3521
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889
Practice Address - Country:US
Practice Address - Phone:301-295-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0209411223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics