Heather N. Petricig, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2083 Issued in ND

Practice address

1101 S Columbia Rd Ste B
Grand Forks, ND 58201-4055

Phone

(218) 230-4352

NPI assigned

Jul 8, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Heather N. Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299715200000",
    "number": "1134358476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 S COLUMBIA RD STE B",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014055",
            "telephone_number": "218-230-4352",
            "fax_number": "701-795-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 S COLUMBIA RD STE B",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014055",
            "telephone_number": "218-230-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRICIG",
        "first_name": "HEATHER",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-08",
        "last_updated": "2011-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6419",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ND",
            "license": "2083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41564",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "JOHNSON",
            "middle_name": "N.",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lexi Marie Peterson
• Mark G Peterson, MD
• Michelle Jo Peterson
• Thomas Michael Peterson, MD
• Timothy A Peterson, MD
• Thomas Victor Petros, PH.D.
• Meagan Pettus
• Rachel Phelps, ATC, LAT
• Madison Phillips-Bischoff
• Abby Phillips

• Dentist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Dentist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.