Organization
DENNIS G PETTIT DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS G. PETTIT DDS (OWNER/PROVIDER)
(937) 878-8694
Entity
Organization
Contact information
Practice address
1762 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6358
(937) 878-8694
Mailing address
1762 COMMERCE CENTER BLVD, FAIRBORN, OH 45324-6358
(937) 878-8694
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
30-01-8161
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0695609
—
OH
Enumeration date
04/15/2010
Last updated
04/23/2010
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