Petra G Lee, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN17627 Issued in FL

Practice address

609 Lamar Ave
Brooksville, FL 34601-3211

Phone

(352) 796-2034

Fax

(888) 581-9789

NPI assigned

Dec 8, 2006

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 25, 2025 through Mar 25, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Petra Gordon DMD PLLC

  • Dentist
  • Brooksville, FL
  • NPI 1154708097
  NPD (past) Authorized official

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1326108754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 LAMAR AVE",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346013211",
            "telephone_number": "352-796-2034",
            "fax_number": "888-581-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 LAMAR AVE",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346013211",
            "telephone_number": "352-796-2034",
            "fax_number": "888-581-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "PETRA",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN17627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sylvia Rita Leaman, ARNP
• Leavitt Medical Associates of Florida Inc
• Ledgeb, LLC
• Christina Lee
• Juwon Lee, MD
• Roxanne Lee, OTR/L
• Desiree Marie Leigh, BS EARLY CHILDHOOD E
• April Lendoiro, MSW, LCSW
• Leonard R Cacioppo MD PA
• Jeffrey J Leonbruno, OCCUPATIONAL THERAPI

• General Practice Dentistry in Brooksville, FL
• Providers in Brooksville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.