Individual
MARK G PETRY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
219 S ADAMS STREET, WELSH, LA 70591
(337) 734-4575
(337) 734-4577
Mailing address
219 S ADAMS STREET, WELSH, LA 70591
(337) 734-4575
(337) 734-4577
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LA4578
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1845787
—
LA
01
—
588176
UNITED CONCORDIA
—
01
—
G7199
BLUE CROSS
LA
Enumeration date
04/06/2006
Last updated
07/08/2007
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