Active NPI
Nelson Mark Petrov, DDS
- General Practice Dentistry
- Elyria, OH
National Provider Identifier
1194890426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12537
- Practice address
- 1212 North Abbe Rd Ste C
Elyria, OH 44035-1649 - Phone
- (440) 366-5530
- Fax
- (440) 366-5211
- NPI assigned
- Nov 21, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12537 | OH | Primary |
Addresses
Primary practice location
1212 North Abbe Rd Ste C
Elyria, OH 44035-1649
Mailing address
1212 North Abbe Rd Ste C
Elyria, OH 44035-1649
Phone (440) 366-5530
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 |
|---|---|---|---|
| 12537 | OH | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nelson M Petrov DDS Inc | General Practice | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194890426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 NORTH ABBE RD STE C",
"city": "ELYRIA",
"state": "OH",
"postal_code": "440351649",
"telephone_number": "440-366-5530",
"fax_number": "440-366-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 NORTH ABBE RD STE C",
"city": "ELYRIA",
"state": "OH",
"postal_code": "440351649",
"telephone_number": "440-366-5530",
"fax_number": "440-366-5211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROV",
"first_name": "NELSON",
"middle_name": "MARK",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "12537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elyria, OH
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.