Provider Demographics
NPI:1104999127
Name:PETITTO, WILLIAM J (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:PETITTO
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RUSSELLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076
Mailing Address - Country:US
Mailing Address - Phone:724-265-1808
Mailing Address - Fax:724-265-1808
Practice Address - Street 1:719 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RUSSELLTON
Practice Address - State:PA
Practice Address - Zip Code:15076
Practice Address - Country:US
Practice Address - Phone:724-265-1808
Practice Address - Fax:724-265-1808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS01384OL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice