Provider Demographics
NPI:1851482004
Name:PETTISANI, FRANK A JR (DMD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:A
Last Name:PETTISANI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361
Mailing Address - Country:US
Mailing Address - Phone:856-691-2553
Mailing Address - Fax:856-691-3370
Practice Address - Street 1:1500 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-691-2553
Practice Address - Fax:856-691-3370
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1018248001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice