Provider Demographics
NPI:1316915788
Name:DAVID M. PETRARCA, DDS & SUNGYON BANG, DMD, P.C.
Entity type:Organization
Organization Name:DAVID M. PETRARCA, DDS & SUNGYON BANG, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PETRARCA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-391-8300
Mailing Address - Street 1:80 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3813
Mailing Address - Country:US
Mailing Address - Phone:781-391-8300
Mailing Address - Fax:
Practice Address - Street 1:80 HIGH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3813
Practice Address - Country:US
Practice Address - Phone:781-391-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty