Provider Demographics
NPI:1942570122
Name:PETRAS, GUS CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:CHARLES
Last Name:PETRAS
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 1:400 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1848
Mailing Address - Country:US
Mailing Address - Phone:530-222-2473
Mailing Address - Fax:530-222-3718
Practice Address - Street 1:400 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1848
Practice Address - Country:US
Practice Address - Phone:530-222-2473
Practice Address - Fax:530-222-3718
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221711223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics