Provider Demographics
NPI:1578819819
Name:PETRONE, ANTHONY ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:PETRONE
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 1:2225 A1A S
Mailing Address - Street 2:SUITE A3
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-2916
Mailing Address - Country:US
Mailing Address - Phone:904-471-7300
Mailing Address - Fax:
Practice Address - Street 1:2225 A1A S
Practice Address - Street 2:SUITE A3
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-2916
Practice Address - Country:US
Practice Address - Phone:904-471-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist