Provider Demographics
NPI:1124644174
Name:PETCU, SERGHEI (DDS)
Entity type:Individual
Prefix:DR
First Name:SERGHEI
Middle Name:
Last Name:PETCU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 S WELLER ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2234
Mailing Address - Country:US
Mailing Address - Phone:469-428-5819
Mailing Address - Fax:
Practice Address - Street 1:3626 FACTORIA BLVD SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6128
Practice Address - Country:US
Practice Address - Phone:425-786-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61063249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist