Provider Demographics
NPI:1699098350
Name:PETLEY, PATRICK J (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:PETLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 BRIGHTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2743
Mailing Address - Country:US
Mailing Address - Phone:412-651-8269
Mailing Address - Fax:
Practice Address - Street 1:5133 BRIGHTWOOD RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2743
Practice Address - Country:US
Practice Address - Phone:412-651-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024517L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice