Dennis G Pettit DDS Inc

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

30-01-8161 Issued in OH

Legal business name

DENNIS G PETTIT DDS INC

Practice address

1762 Commerce Center Blvd
Fairborn, OH 45324-6358

Phone

(937) 878-8694

NPI assigned

Apr 15, 2010

Last updated

Apr 23, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dennis G. Pettit, DDSNPI 1356354765

Title

Owner/Provider

Phone

(937) 878-8694

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dennis G Pettit, DDS

  • Oral and Maxillofacial Pathology Dentistry
  • Fairborn, OH
  • NPI 1356354765
  Authorized official Same address or phone
• Matthew Ian Pettit, DMD

  • Dentist
  • Fairborn, OH
  • NPI 1487338679
  NPD

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

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271980800000",
    "number": "1356667323",
    "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": "453246358",
            "telephone_number": "937-878-8694"
        },
        {
            "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": [],
    "basic": {
        "organization_name": "DENNIS G PETTIT DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2010-04-23",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "937-878-8694",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30-01-8161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0695609",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebeca Alexis Jashal Decson
• Peter Dedominici, LSW
• Shana Degnan
• Peter Joseph Dempsey, D.O.
• Adrienne Dendy
• Dennis MC Whorter
• Manoj R. Desai, M.D.
• Amy Detrick
• Jennifer Diamond
• Danielle Kayleen Dierker

• Oral and Maxillofacial Surgery Clinic/Center in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; 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.