Thomas P Petrick Jr., DMD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

CT007691 Issued in CT

Practice address

157 Goose Lane
Guilford, CT 06437-2100

Phone

(203) 453-4475

Fax

(203) 453-3314

NPI assigned

Sep 20, 2006

Last updated

Mar 7, 2023By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thomas P. Petrick DMD and Theodore J. Katz DDS, PC

  • General Practice Dentistry
  • Guilford, CT
  • NPI 1003903683
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1043318421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 GOOSE LANE",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372100",
            "telephone_number": "203-453-4475",
            "fax_number": "203-453-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 GOOSE LANE",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372100",
            "telephone_number": "203-453-4475",
            "fax_number": "203-453-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRICK",
        "first_name": "THOMAS",
        "middle_name": "P",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "CT007691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "007691",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Grace Peri, L.C.S.W.
• Fallon Terese Perrelli, DPT
• Personal Wellness Physical Therapy LLC
• Marissa Pesce, MS, OTR/L
• Jill Anne Peterson, RN, MSN, CPNP
• Katerina Philbrick, LPC
• Physical Therapy Specialists
• Physical Therapy Specialists
• Physicians Alliance of Connecticut, LLC
• Physiotherapy Associates Inc

• Family Medicine Physician in Guilford, CT
• Providers in Guilford, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.