Active NPI
Vennessa Petrov
- Dental Assistant
- Clackamas, OR
National Provider Identifier
1316653132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- Practice address
- 10209 SE Sunnyside Rd
Clackamas, OR 97015-9782 - Phone
- (800) 813-2000
- NPI assigned
- Jan 25, 2023
- Last updated
- Jan 25, 2023
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | OR | Primary |
Addresses
Primary practice location
10209 SE Sunnyside Rd
Clackamas, OR 97015-9782
Mailing address
15680 SE Monner Rd
Happy Valley, OR 97086-5813
Phone (509) 539-4852
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674604800000",
"number": "1316653132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15680 SE MONNER RD",
"city": "HAPPY VALLEY",
"state": "OR",
"postal_code": "970865813",
"telephone_number": "509-539-4852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10209 SE SUNNYSIDE RD",
"city": "CLACKAMAS",
"state": "OR",
"postal_code": "970159782",
"telephone_number": "800-813-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROV",
"first_name": "VENNESSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-25",
"last_updated": "2023-01-25",
"certification_date": "2023-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "OR",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clackamas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.