Provider Demographics
NPI:1285123414
Name:PETTIT, KAREN F (DDS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:F
Last Name:PETTIT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14713 HERONGLEN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3868
Mailing Address - Country:US
Mailing Address - Phone:520-366-6592
Mailing Address - Fax:
Practice Address - Street 1:6020 FL-70 UNIT 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4377
Practice Address - Country:US
Practice Address - Phone:813-889-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24008122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist