Active NPI
Rebecca Petts, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Cleveland, OH
National Provider Identifier
1407417140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- RES.004157
- Practice address
- 9601 Chester Ave
Cleveland, OH 44106 - Phone
- (216) 368-8665
- NPI assigned
- Jun 24, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | RES.004157 | OH | Primary |
Addresses
Primary practice location
9601 Chester Ave
Cleveland, OH 44106
Mailing address
30842 Kilgour Dr
Westlake, OH 44145-6835
Phone (440) 226-0097
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RES.004157 | Medicaid | OH |
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 |
|---|---|---|---|
| RES.004157 | OH | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561334400000",
"number": "1407417140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30842 KILGOUR DR",
"city": "WESTLAKE",
"state": "OH",
"postal_code": "441456835",
"telephone_number": "440-226-0097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9601 CHESTER AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "44106",
"telephone_number": "216-368-8665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTS",
"first_name": "REBECCA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-24",
"last_updated": "2019-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "OH",
"license": "RES.004157",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "RES.004157",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.