Provider Demographics
NPI:1255420642
Name:PETTINATO, ERIKA SUE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:SUE
Last Name:PETTINATO
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:ERIKA
Other - Middle Name:PETTINATO
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:5475 SADDLEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4339
Mailing Address - Country:US
Mailing Address - Phone:813-857-6579
Mailing Address - Fax:
Practice Address - Street 1:14497 N DALE MABRY HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2047
Practice Address - Country:US
Practice Address - Phone:813-265-1200
Practice Address - Fax:813-265-1203
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146441223P0221X
TXDN198861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry