Organization
MARK M. PETRYNA,D.D.S.,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK MARIAN PETRYNA D.D.S. (ORAL SURGEON)
(704) 847-7799
Entity
Organization
Contact information
Practice address
1348 MATTHEWS TOWNSHIP PKWY, SUITE 101, MATTHEWS, NC 28105-4929
(704) 847-7799
(704) 849-7925
Mailing address
1348 MATTHEWS TOWNSHIP PKWY, SUITE 101, MATTHEWS, NC 28105-4929
(704) 847-7799
(704) 849-7925
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6075
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
476352
UNITED CONCORDIA
NC
01
—
9705A
BCBS OF NC
NC
Enumeration date
05/21/2007
Last updated
08/22/2020
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