Individual
MARK M PETRYNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1348 MATTHEWS TOWNSHIP PKWY, SUITE 101, MATTHEWS, NC 28105
(704) 847-7799
(704) 849-7925
Mailing address
1348 MATTHEWS TOWNSHIP PARKWAY, SUITE 101, MATTHEWS, NC 28105
(704) 847-7799
(704) 849-7925
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
NC6075
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
476352
UNITED CONCORDIA
NC
01
—
9705A
BCBS OF NC
NC
Enumeration date
02/22/2007
Last updated
07/08/2007
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