J. Jerome Petro DMD Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS-019044L Issued in PA

Legal business name

J. JEROME PETRO DMD INC

Practice address

909 Menoher Blvd
Johnstown, PA 15905-2834

Phone

(814) 536-8793

NPI assigned

Feb 23, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. J. Jerome Petro, DMD

Title

President

Phone

(814) 536-8793

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174658645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159052834",
            "telephone_number": "814-536-8793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 MENOHER BLVD",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159052834",
            "telephone_number": "814-536-8793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. JEROME PETRO DMD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETRO",
        "authorized_official_first_name": "J.",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-536-8793",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-019044L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Douglas Jackson, MD
• Jo Ann Jacobs, COTA/L
• Lindsey Jacobs

• General Practice Dentistry in Johnstown, PA
• Providers in Johnstown, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.