Provider Demographics
NPI:1306008057
Name:PETRUZZI, STEVEN J (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:PETRUZZI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 NE 65TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-1032
Mailing Address - Country:US
Mailing Address - Phone:760-218-1638
Mailing Address - Fax:
Practice Address - Street 1:4025 W BELL RD STE 18
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2749
Practice Address - Country:US
Practice Address - Phone:602-843-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009012760122300000X
AZD0081621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry