Provider Demographics
NPI:1629172978
Name:PETCHALONIS, ANTHONY X (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:X
Last Name:PETCHALONIS
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 1:248 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4819
Mailing Address - Country:US
Mailing Address - Phone:215-732-3350
Mailing Address - Fax:215-732-2424
Practice Address - Street 1:248 S 21ST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4819
Practice Address - Country:US
Practice Address - Phone:215-732-3350
Practice Address - Fax:215-732-2424
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice