Provider Demographics
NPI:1821016635
Name:PETTINATO, SCOTT J (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:PETTINATO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:821 OAK ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1260
Mailing Address - Country:US
Mailing Address - Phone:570-558-9900
Mailing Address - Fax:570-558-9922
Practice Address - Street 1:821 OAK ST
Practice Address - Street 2:SUITE #2
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1260
Practice Address - Country:US
Practice Address - Phone:570-558-9900
Practice Address - Fax:570-558-9922
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS-028929L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice