Provider Demographics
NPI:1588838924
Name:PETREY, JOSEPH STANLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STANLEY
Last Name:PETREY
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 1:224 LANGDON STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-451-0771
Mailing Address - Fax:606-451-0780
Practice Address - Street 1:224 LANGDON STREET
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-451-0771
Practice Address - Fax:606-451-0780
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY82981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics