Active NPI
Christopher M Pennisi, DDS
- Dentist
- Moncure, NC
National Provider Identifier
1104037936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8394
- Practice address
- 7228 Pittsboro-Moncure Rd
Moncure, NC 27559 - Phone
- (919) 542-4991
- Fax
- (919) 542-3726
- NPI assigned
- May 24, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8394 | NC | Primary |
Addresses
Primary practice location
7228 Pittsboro-Moncure Rd
Moncure, NC 27559
Mailing address
410 Brook Creek Dr
Cary, NC 27519-6124
Phone (919) 387-6377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160912000827 | NC | Order and Referring Only - Dentist | 8123314515 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8394 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1104037936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 BROOK CREEK DR",
"city": "CARY",
"state": "NC",
"postal_code": "275196124",
"telephone_number": "919-387-6377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7228 PITTSBORO-MONCURE RD",
"city": "MONCURE",
"state": "NC",
"postal_code": "27559",
"telephone_number": "919-542-4991",
"fax_number": "919-542-3726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNISI",
"first_name": "CHRISTOPHER",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "8394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moncure, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.