Andrew Frank Petlak, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

003-019016812-02 Issued in IL

Practice address

121 S Wilke Rd
Suite 202
Arlington Heights, IL 60005-1533

Phone

(847) 255-0909

Fax

(847) 255-1339

NPI assigned

Apr 20, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821215633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 S WILKE RD",
            "address_2": "SUITE 202",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051533",
            "telephone_number": "847-255-0909",
            "fax_number": "847-255-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S WILKE RD",
            "address_2": "SUITE 202",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051533",
            "telephone_number": "847-255-0909",
            "fax_number": "847-255-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETLAK",
        "first_name": "ANDREW",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "003-019016812-02",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John R. Peters, M.D.
• Shirley Peters, PHARMD
• Georgia Jean Petersen, SLP
• Andrew Peterson, OD
• Christine Patricia Peterson
• Michelle R. Petrak, PH.D., CCC-A
• Brianne E Petrey
• Alexis Gabrielle Petrielli
• Gabriela Daniel Petrova
• Stela Petrova, DOULA

• General Practice Dentistry in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.