Dr Marvin William Petashnick, DDS is a
Dentist based in Fondulac, Wisconsin. Dr Marvin William Petashnick is licensed to practice in Wisconsin (license number 40019521) and his current practice location is
545 E Johnson St, Fondulac, Wisconsin. He can be reached at his office (for appointments etc.) via phone at
(920) 924-9090.
NPI number for Dr Marvin William Petashnick is 1932113800 and his current mailing address is 5438 W Lake Dr, West Bend, Wisconsin. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1932113800.
Healthcare Provider's Profile
| Full Name | Dr Marvin William Petashnick |
|---|
| Gender | Male |
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| Speciality | Dentist |
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| Location | 545 E Johnson St, Fondulac, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1932113800
- Provider Enumeration Date: 07/28/2006
- Last Update Date: 07/08/2007
Medical Identifiers
Medical identifiers for Dr Marvin William Petashnick such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1932113800 | NPI | - | NPPES |
| 33519300 | Medicaid | WI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | 40019521 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Marvin William Petashnick is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Marvin William Petashnick, DDS
5438 W Lake Dr,
West Bend, WI 53095
Ph: (262) 644-8289 | Dr Marvin William Petashnick, DDS
545 E Johnson St,
Fondulac, WI 54935
Ph: (920) 924-9090 |
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