Provider Demographics
NPI:1477571578
Name:PETRILLO, PATRICK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:PETRILLO
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 1:8 SHADY GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2132
Mailing Address - Country:US
Mailing Address - Phone:215-345-7703
Mailing Address - Fax:
Practice Address - Street 1:176 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5434
Practice Address - Country:US
Practice Address - Phone:610-326-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA162461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice