Scott Fraser Petrie, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

16601 Issued in MA

Practice address

1428 Main St
Suite 1
Walpole, MA 02081

Phone

(508) 668-8008

Fax

(508) 668-8808

NPI assigned

Jul 24, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

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

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.

• Dental Associates of Walpole

  • General Practice Dentistry
  • Walpole, MA
  • NPI 1255411831

  Pediatric Dentistry

  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063434983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 GRACE DR",
            "city": "MEDFIELD",
            "state": "MA",
            "postal_code": "020522819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 MAIN ST",
            "address_2": "SUITE 1",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "02081",
            "telephone_number": "508-668-8008",
            "fax_number": "508-668-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "SCOTT",
        "middle_name": "FRASER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MA",
            "license": "16601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA",
            "identifier": "000708",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "X10973",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Smiles of Walpole LLC
• Mariah M Pelkey, LPN
• Kendra Pennine, DC
• Personalized Psychological Consulting LLC
• Kristen S Pessa
• Lisa Ann Petrosevich
• Pharmagears LLC
• Danielle Phinney
• Phoemix Ark Human Services, LLC
• Adrian Pieleanu, MD

• Pediatric Dentistry in Walpole, MA
• Providers in Walpole, MA by specialty
• Pediatric Dentistry in Massachusetts

• 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.
• 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.