Active NPI
Dennis G Pettit, DDS
- Oral and Maxillofacial Pathology Dentistry
- Fairborn, OH
National Provider Identifier
1356354765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 30018161
- Practice address
- 1762 Commerce Center Blvd
Fairborn, OH 45324-6358 - Phone
- (937) 878-8694
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 30-01-8161 | OH | |
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 30018161 | OH | Primary |
Addresses
Primary practice location
1762 Commerce Center Blvd
Fairborn, OH 45324-6358
Mailing address
1762 Commerce Center Blvd
Fairborn, OH 45324
Phone (937) 878-8694
Other practice location 1
2225 N Limestone St
Springfield, OH 45503-2635
Phone (937) 399-0164
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30018161 | OH | MD | Oral and Maxillofacial Pathology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787788800000",
"number": "1356354765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1762 COMMERCE CENTER BLVD",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "45324",
"telephone_number": "937-878-8694",
"fax_number": "937-878-1554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1762 COMMERCE CENTER BLVD",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453246358",
"telephone_number": "937-878-8694"
}
],
"practiceLocations": [
{
"address_1": "2225 N Limestone St",
"address_purpose": "LOCATION",
"city": "Springfield",
"state": "OH",
"postal_code": "455032635",
"country_code": "US",
"telephone_number": "937-399-0164",
"fax_number": "937-399-7299",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETTIT",
"first_name": "DENNIS",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2026-08-27",
"certification_date": "2026-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "OH",
"license": "30-01-8161",
"primary": false
},
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "OH",
"license": "30018161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.