Provider Demographics
NPI:1356473276
Name:STEPHEN G. PETINGE D.M.D
Entity Type:Organization
Organization Name:STEPHEN G. PETINGE D.M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PETINGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-233-8248
Mailing Address - Street 1:15 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-4309
Mailing Address - Country:US
Mailing Address - Phone:781-233-8248
Mailing Address - Fax:781-233-1385
Practice Address - Street 1:15 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4309
Practice Address - Country:US
Practice Address - Phone:781-233-8248
Practice Address - Fax:781-233-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty