Individual
JAMES C PETTIGREW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3003
(352) 273-6775
(352) 392-2507
Mailing address
PO BOX 918025, ORLANDO, FL 32891-8025
(352) 273-6775
(352) 392-2507
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
DTP312
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DTP312
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073322900
—
FL
05
—
73322900
—
FL
Enumeration date
03/16/2006
Last updated
04/23/2008
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