Provider Demographics
NPI:1972600088
Name:PETROCCHI, SANDRA M (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:PETROCCHI
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 1:8115 PRESTON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225
Mailing Address - Country:US
Mailing Address - Phone:214-363-9664
Mailing Address - Fax:214-363-9921
Practice Address - Street 1:8115 PRESTON RD
Practice Address - Street 2:STE 130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:214-363-9664
Practice Address - Fax:214-363-9921
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist