Kevin T. Petrie, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5763 Issued in KS

Practice address

3455 W 13TH St N
Wichita, KS 67203-4500

Phone

(316) 945-0543

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Arthur Unruh DDS LLC

  • Dentist
  • Wichita, KS
  • NPI 1700333242
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1144325671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12126 W HUNTERSVIEW ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672351220",
            "telephone_number": "316-721-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 W 13TH ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672034500",
            "telephone_number": "316-945-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "KEVIN",
        "middle_name": "T.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "5763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10022250A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID",
            "identifier": "7849",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy L Peterson, M.D.
• Susan S Peterson
• Patricia Petrakis, MD
• Shannon Petricek, LMFT
• David Earl Petrie, MD
• Janelle R Petrisor
• Juliana M Petro
• Mary Pettiette, OT
• David A Petty I, PTA
• Chelsea Peyton, AUD, CCC-A, FAAA

• General Practice Dentistry in Wichita, KS
• Providers in Wichita, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.