Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN26052 | FL |
NPI | 1003589367 |
---|---|
Provider Name | Dr. Patrick Pietrzak |
First Address | Saint Augustine, FL 32080-8307 |
Second Address | Saint Augustine, FL 32080-8307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2021 |
Last Update Date | 31/07/2021 |