Provider Demographics
NPI:1023693348
Name:PETRONE, PAULA (RDH-BS OMT)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:PETRONE
Suffix:
Gender:F
Credentials:RDH-BS OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 RADCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1225
Mailing Address - Country:US
Mailing Address - Phone:516-260-8160
Mailing Address - Fax:
Practice Address - Street 1:142 RADCLIFF DR
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1225
Practice Address - Country:US
Practice Address - Phone:516-260-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025978124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist