Provider Demographics
NPI:1669438818
Name:FRANK T. PETRUZZELLO, D.D.S., P.C.
Entity Type:Organization
Organization Name:FRANK T. PETRUZZELLO, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:PETRUZZELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-978-3900
Mailing Address - Street 1:8202 IRVING RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4614
Mailing Address - Country:US
Mailing Address - Phone:586-978-3900
Mailing Address - Fax:586-978-0214
Practice Address - Street 1:8202 IRVING RD
Practice Address - Street 2:SUITE 300
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4614
Practice Address - Country:US
Practice Address - Phone:586-978-3900
Practice Address - Fax:586-978-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010175051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty