Provider Demographics
NPI:1346735024
Name:PETROTTO, CHRISTOPHER ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANTHONY
Last Name:PETROTTO
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 1:315 W BUSCH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7904
Mailing Address - Country:US
Mailing Address - Phone:716-880-4736
Mailing Address - Fax:
Practice Address - Street 1:315 W BUSCH BLVD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7904
Practice Address - Country:US
Practice Address - Phone:813-642-7555
Practice Address - Fax:813-898-2893
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist