Provider Demographics
NPI:1346303948
Name:PETTINATO, TIERNEY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIERNEY
Middle Name:M
Last Name:PETTINATO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14497 N DALE MABRY HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2047
Mailing Address - Country:US
Mailing Address - Phone:954-471-8984
Mailing Address - Fax:
Practice Address - Street 1:5252 VILLAGE MARKET
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8400
Practice Address - Country:US
Practice Address - Phone:813-778-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice