Active NPI
Peter Paul Patellis, D.M. D.
- Dentist
- Kennett Square, PA
National Provider Identifier
1174678205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS0296924L
- Practice address
- 208 N Union St
Kennett Square, PA 19348-2925 - Phone
- (610) 444-6311
- Fax
- (610) 444-6153
- NPI assigned
- Jan 25, 2007
- Last updated
- Jul 8, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS0296924L | PA | Primary |
| Dentist | 122300000X | G1-0001195 | DE |
Addresses
Primary practice location
208 N Union St
Kennett Square, PA 19348-2925
Mailing address
208 N Union St
Kennett Square, PA 19348-2925
Phone (610) 444-6311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G1-0001195 | DE | MD | Dentist |
| DS0296924L | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peter P. Patellis, DMD, PA | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba The Kennett Center for Advanced Dentistry
- Dental Clinic/Center
- Kennett Square, PA
- NPI 1437286994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174678205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 N UNION ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193482925",
"telephone_number": "610-444-6311",
"fax_number": "610-444-6153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 N UNION ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193482925",
"telephone_number": "610-444-6311",
"fax_number": "610-444-6153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATELLIS",
"first_name": "PETER",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "D.M. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS0296924L",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "DE",
"license": "G1-0001195",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennett Square, PA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.