Provider Demographics
NPI:1912006834
Name:PETIX, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:PETIX
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 1:381 S LITTLE TOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1427
Mailing Address - Country:US
Mailing Address - Phone:845-634-5208
Mailing Address - Fax:845-638-4389
Practice Address - Street 1:381 S LITTLE TOR RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1427
Practice Address - Country:US
Practice Address - Phone:845-634-5208
Practice Address - Fax:845-638-4389
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice