Provider Demographics
NPI:1669587978
Name:PETKANAS, JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:PETKANAS
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 1:777 TERRACE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-3102
Mailing Address - Country:US
Mailing Address - Phone:201-703-0100
Mailing Address - Fax:201-703-0101
Practice Address - Street 1:777 TERRACE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-3102
Practice Address - Country:US
Practice Address - Phone:201-703-0100
Practice Address - Fax:201-703-0101
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02019600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist