Petry, Jerod Paul

Petry, Jerod Paul is an individual health care provider with primary practice located at 2900 Moss St Suite D, Lafayette LA 70501. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / Dentist is his primary health care specialty. Petry, Jerod Paul can be contacted via phone (337) 233-5494.

Contact Information

Primary practice address
2900 Moss St Suite D Lafayette LA 70501
Phone: (337) 233-5494
Fax: (337) 233-6150
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 5653 Louisiana
Dental Providers / General Practice 1223G0001X 5653 Louisiana

Profile Details

NPI number 1518904317
LBN Legal business name Petry, Jerod Paul
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518904317 NPPES
Louisiana MEDICAID 1856533

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