Active NPI
Gail Y. Pettis, DDS, MMED.SC.
- Dentist
- Seattle, WA
National Provider Identifier
1275824872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00007559
- Practice address
- 10564 5TH Ave NE
#205
Seattle, WA 98125-7200 - Phone
- (206) 351-1122
- NPI assigned
- Apr 29, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DE00007559 | WA | Primary |
Addresses
Primary practice location
10564 5TH Ave NE
#205
Seattle, WA 98125-7200
Mailing address
PO Box 1405
Mercer Island, WA 98040-1405
Phone (425) 830-3255
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 |
|---|---|---|---|
| DE00007559 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304035200000",
"number": "1275824872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1405",
"city": "MERCER ISLAND",
"state": "WA",
"postal_code": "980401405",
"telephone_number": "425-830-3255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10564 5TH AVE NE",
"address_2": "#205",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981257200",
"telephone_number": "206-351-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIS",
"first_name": "GAIL",
"middle_name": "Y.",
"name_prefix": "Dr.",
"credential": "DDS, MMED.SC.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-29",
"last_updated": "2011-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00007559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.