John Petrucci DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019019714 Issued in IL

Legal business name

JOHN PETRUCCI DDS

Practice address

328 E Army Trail Rd
Glendale HTS, IL 60139

Phone

(630) 924-5579

NPI assigned

May 19, 2008

Organization subpart

No

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

Authorized official

Name

Dr. John Petrucci, DDSNPI 1124184049

Title

Owner

Phone

(630) 924-5579

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Petrucci, DDS

  • General Practice Dentistry
  • Glendale Heights, IL
  • NPI 1124184049
  NPD (past) Authorized official

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1346407335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 E ARMY TRAIL RD",
            "city": "GLENDALE HTS",
            "state": "IL",
            "postal_code": "60139",
            "telephone_number": "630-924-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328 E ARMY TRAIL RD",
            "city": "GLENDALE HTS",
            "state": "IL",
            "postal_code": "60139",
            "telephone_number": "630-924-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN PETRUCCI DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "PETRUCCI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-924-5579",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019019714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019019714",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Glendale HTS, IL
• Providers in Glendale HTS, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.