Provider Demographics
NPI:1881754521
Name:PETTINATO, FRANK CARMEN II (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:CARMEN
Last Name:PETTINATO
Suffix:II
Gender:M
Credentials:DMD, MS
Other - Prefix:
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Mailing Address - Street 1:14985 TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287
Mailing Address - Country:US
Mailing Address - Phone:941-841-1010
Mailing Address - Fax:941-841-9757
Practice Address - Street 1:14985 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287
Practice Address - Country:US
Practice Address - Phone:941-841-1010
Practice Address - Fax:941-841-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075508700Medicaid