Individual
MR. WILLIAM TODD PETREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2725 US HWY 25 N, EAST BERNSTADT, KY 40729
(606) 843-6476
(606) 843-6176
Mailing address
PO BOX 5131, LONDON, KY 40745-5131
(606) 843-6476
(606) 843-6176
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7236
KY
1223G0001X
General Practice Dentistry
Primary
7236
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45001393
EPSDT
KY
05
—
60072360
—
KY
Enumeration date
09/06/2006
Last updated
02/06/2012
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