Paul Peter Petrunak Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS019080L Issued in PA

Practice address

1161 Franklin St
Johnstown, PA 15905

Phone

(814) 539-2182

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255411856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1161 FRANKLIN ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15905",
            "telephone_number": "814-539-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1161 FRANKLIN ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "15905",
            "telephone_number": "814-539-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUNAK",
        "first_name": "PAUL",
        "middle_name": "PETER",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS019080L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Pessolano
• Tara L. Peters, CRNP
• Keshia Jo Peterson, RN
• Nicholas Joseph Petrilla
• Suzanne E Petrore, AU.D.,FAAA
• William Phat-Nam Pham, DO
• Debra Phillips, CW
• Phoenix Rehabilitation and Health Services, Inc.
• Physicians Dialysis Acquisitions Inc
• Robert G Pickerill, M.D.

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.