Provider Demographics
NPI:1437286994
Name:PETER P. PATELLIS, DMD, PA
Entity Type:Organization
Organization Name:PETER P. PATELLIS, DMD, PA
Other - Org Name:THE KENNETT CENTER FOR ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-444-6311
Mailing Address - Street 1:208 NORTH UNION ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-444-6311
Mailing Address - Fax:610-444-6153
Practice Address - Street 1:208 NORTH UNION ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-444-6311
Practice Address - Fax:610-444-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental