John Adam Petty, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11708 Issued in MN

Practice address

17821 Highway 7 Ste 2F
Minnetonka, MN 55345-4113

Phone

(952) 474-5622

Fax

(952) 474-0283

NPI assigned

Dec 15, 2006

Sex

Male

Sole proprietor

No

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.

• PDG, P.a.

  • General Practice Dentistry
  • Minnetonka, MN
  • NPI 1669530101
  NPD (past) GENERAL PRACTICE
• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Lakewood, WI
  • NPI 1699778233
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437211448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11256 DEER RIDGE LN",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434122",
            "telephone_number": "952-933-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17821 HIGHWAY 7 STE 2F",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454113",
            "telephone_number": "952-474-5622",
            "fax_number": "952-474-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JOHN",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54913400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Marie Frischmann Peterson, PSYD, LP
• Sieglinde Iris Peterson, M.D.
• Melissa Ann Petoletti, MS, LPCC, LADC
• Mary Petruzzi, APRN
• Laura Marie Pett, MA CCC A
• Jennifer Petzoldt
• Crystal A Pfisterer, D.C.
• Laura Jean Philbrook, RN
• Elizabeth Lowe Robinson Phillips, DDS
• Megan Phillips, MSW, LICSW

• All providers in Minnetonka, MN
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.