Individual
TIMOTHY JAMES PETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-0001
(414) 384-2000
Mailing address
706 E JUNEAU AVE # 3, MILWAUKEE, WI 53202-2709
(402) 206-1986
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001406-15
WI
Other
Enumeration date
08/09/2016
Last updated
08/09/2016
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