Provider Demographics
NPI:1669552279
Name:PETSCHE, PAUL EDWARD (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:PETSCHE
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:2760 SE 17TH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5571
Mailing Address - Country:US
Mailing Address - Phone:352-732-6006
Mailing Address - Fax:352-732-6026
Practice Address - Street 1:2760 SE 17TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5571
Practice Address - Country:US
Practice Address - Phone:352-732-6006
Practice Address - Fax:352-732-6026
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN152251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics