Provider Demographics
NPI:1982622122
Name:PETTENGILL, MARINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:PETTENGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:74 TAUNTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2166
Mailing Address - Country:US
Mailing Address - Phone:508-699-2221
Mailing Address - Fax:508-699-2910
Practice Address - Street 1:74 TAUNTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2166
Practice Address - Country:US
Practice Address - Phone:508-699-2221
Practice Address - Fax:508-699-2910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice