Active NPI
Derek Andrew Petty, DDS
- Dentist
- Arlington, TX
National Provider Identifier
1356930648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 36800
- Practice address
- 4050 W Interstate 20
Arlington, TX 76017-1435 - Phone
- (903) 519-9134
- NPI assigned
- Jan 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 36800 | TX | Primary |
Addresses
Primary practice location
4050 W Interstate 20
Arlington, TX 76017-1435
Mailing address
2801 Live Oak St Apt 5203
Dallas, TX 75204-5732
Phone (903) 519-9134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36800 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610409600000",
"number": "1356930648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 LIVE OAK ST APT 5203",
"city": "DALLAS",
"state": "TX",
"postal_code": "752045732",
"telephone_number": "903-519-9134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4050 W INTERSTATE 20",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760171435",
"telephone_number": "903-519-9134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "DEREK",
"middle_name": "ANDREW",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-12",
"last_updated": "2021-01-12",
"certification_date": "2021-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "36800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.