Provider Demographics
NPI:1316393390
Name:PETRIK, ERIN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MARIE
Last Name:PETRIK
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 1:2530 N CLARK ST
Mailing Address - Street 2:APT 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4972
Mailing Address - Country:US
Mailing Address - Phone:612-290-1434
Mailing Address - Fax:
Practice Address - Street 1:2530 N CLARK ST
Practice Address - Street 2:APT 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4972
Practice Address - Country:US
Practice Address - Phone:612-290-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0306021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry