Provider Demographics
NPI:1801041652
Name:CRISTIAN PETCU DDS PC
Entity Type:Organization
Organization Name:CRISTIAN PETCU DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETCU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-533-8433
Mailing Address - Street 1:89C MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1821
Mailing Address - Country:US
Mailing Address - Phone:508-533-8433
Mailing Address - Fax:508-533-4682
Practice Address - Street 1:89C MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1821
Practice Address - Country:US
Practice Address - Phone:508-533-8433
Practice Address - Fax:508-533-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty