Peter J Broccoli

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401419456 Issued in VA

Practice address

1807 Huguenot Rd Ste 120
Midlothian, VA 23113-5604

Phone

(804) 354-1600

NPI assigned

Apr 14, 2021

Sex

Male

Sole proprietor

No

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

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Commonwealth Oral & Facial Surgery, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Richmond, VA
  • NPI 1144274382
  NPD

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1356921142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71930",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232551930",
            "telephone_number": "804-354-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 HUGUENOT RD STE 120",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231135604",
            "telephone_number": "804-354-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7009 Lee Park Rd",
            "address_purpose": "LOCATION",
            "city": "Mechanicsville",
            "state": "VA",
            "postal_code": "231113682",
            "country_code": "US",
            "telephone_number": "804-354-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCCOLI",
        "first_name": "PETER",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401419456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George M Bright, M.D.
• McRae Rogers Brittingham, CPD
• Madelyn Britton
• Anne Broadhead, DPT
• Rebecca A Brobston, NP
• Deborah K Brokaw, PHARM.D., BCACP
• Lindsey Anne Brookmire
• Kaitlyn Brooks
• Charlotte Devon Brown
• David McArthur Brown, PT

• Oral and Maxillofacial Surgery (Dentist) in Midlothian, VA
• Providers in Midlothian, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.