Provider Demographics
NPI:1649441098
Name:A. GIL PETTIT III, D.D.S., P.A.
Entity type:Organization
Organization Name:A. GIL PETTIT III, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:GILDEROY
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-686-3619
Mailing Address - Street 1:9111 MARKET ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7995
Mailing Address - Country:US
Mailing Address - Phone:910-686-3619
Mailing Address - Fax:910-686-7165
Practice Address - Street 1:9111 MARKET ST
Practice Address - Street 2:UNIT B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7995
Practice Address - Country:US
Practice Address - Phone:910-686-3619
Practice Address - Fax:910-686-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5676261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental