Provider Demographics
NPI:1740202662
Name:PETRAKOS, FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:PETRAKOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:11695 MARKET STREET
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452
Mailing Address - Country:US
Mailing Address - Phone:330-549-2800
Mailing Address - Fax:330-549-2660
Practice Address - Street 1:11695 MARKET STREET
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452
Practice Address - Country:US
Practice Address - Phone:330-549-2800
Practice Address - Fax:330-549-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20416122300000X
OH20466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2188010Medicaid
OH2188010Medicaid