| Organization Name: | PETITO ORAL SURGERY |
| NPI Number: | 1134414154 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTHONY ROCCO PETITO (OWNER) |
| Mailing Address: | 400 Massasoit Ave Suite 103 East Providence |
| State: | RI US |
| Postal Code: | 029142012 |
| Phone Number: | 4015781866 |
| Fax Number: | 5083366580 |
| NPI Enumeration Date: | 06/17/2011 |
| NPI Last Update Date: | 06/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2552 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |