Provider Demographics
NPI:1467535971
Name:PERETICH, DAVID M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PERETICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 ARDMORE BLVD
Mailing Address - Street 2:SUITE #121
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4685
Mailing Address - Country:US
Mailing Address - Phone:412-271-1602
Mailing Address - Fax:412-271-1663
Practice Address - Street 1:2020 ARDMORE BLVD
Practice Address - Street 2:SUITE #121
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4685
Practice Address - Country:US
Practice Address - Phone:412-271-1602
Practice Address - Fax:412-271-1663
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO20648L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA131827OtherUNITED CONCORDIA INS.