Provider Demographics
NPI:1609846302
Name:PETTIETTE, MARY T (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:PETTIETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:91 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-295-9950
Mailing Address - Fax:801-640-9294
Practice Address - Street 1:91 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-9950
Practice Address - Fax:801-640-9294
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics