Provider Demographics
NPI:1710048384
Name:PETTEY, DAVID C (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:PETTEY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 SUMMER KNOLL CV
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2859
Mailing Address - Country:US
Mailing Address - Phone:901-373-7144
Mailing Address - Fax:
Practice Address - Street 1:6603 SUMMER KNOLL CV
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2859
Practice Address - Country:US
Practice Address - Phone:901-373-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3012-971223G0001X
TN103491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice