Provider Demographics
NPI:1689686016
Name:PETRUZZELLO, FRANK T (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:T
Last Name:PETRUZZELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010175051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice