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Individual
KEVIN T. PETRIE
Active
Individual
KEVIN T. PETRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5763
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10022250A
—
KS
01
—
7849
BCBS ID
KS
Enumeration date
09/13/2006
Last updated
07/09/2007
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