Individual
DR. PAUL S PETRUNGARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
330 W FRONTAGE RD FL 2B, NORTHFIELD, IL 60093-3467
(847) 386-6351
(847) 386-7169
Mailing address
330 W FRONTAGE RD FL 2B, NORTHFIELD, IL 60093-3467
(847) 386-6351
(847) 386-7169
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.020118
IL
1223P0300X
Periodontics
021.001401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D11084
STATE DENTAL LICENSE
MN
Enumeration date
12/06/2006
Last updated
02/08/2018
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