Basic Information
| Provider Information | |||||||||
| NPI: | 1336438910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRASHEUSKAYA | ||||||||
| FirstName: | MARYNA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 STATE ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165011914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144544530 | ||||||||
| FaxNumber: | 8144562375 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 STATE STREET | ||||||||
| Address2: | 465 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568548 | ||||||||
| FaxNumber: | 8144559015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2011 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | DS039227 | PA | Y | Dental Providers | Dentist |
No ID Information.