Provider Demographics
NPI:1841493145
Name:PETRINI, JOHN J (DOCTOR DENTAL SURGER)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PETRINI
Suffix:
Gender:M
Credentials:DOCTOR DENTAL SURGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:500 SUTTER ST
Mailing Address - Street 2:# 600
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102
Mailing Address - Country:US
Mailing Address - Phone:415-986-5323
Mailing Address - Fax:415-986-6153
Practice Address - Street 1:500 SUTTER ST
Practice Address - Street 2:# 600
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-986-5323
Practice Address - Fax:415-986-6153
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice