Active NPI
Katie Rose Petrola, DDS
- Dentist
- Kernersville, NC
National Provider Identifier
1508279720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10100
- Practice address
- 1695 Kernersville Medical Pkwy
Kernersville, NC 27284-7159 - Phone
- (336) 716-2160
- NPI assigned
- Jun 5, 2014
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10100 | NC | Primary |
Addresses
Primary practice location
1695 Kernersville Medical Pkwy
Kernersville, NC 27284-7159
Mailing address
161 Sprunt St
Chapel Hill, NC 27517-7810
Phone (513) 417-4191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151103002987 | NC | Order and Referring Only - Oral Surgery | 3072823095 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10100 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765929600000",
"number": "1508279720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 SPRUNT ST",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275177810",
"telephone_number": "513-417-4191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1695 KERNERSVILLE MEDICAL PKWY",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847159",
"telephone_number": "336-716-2160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROLA",
"first_name": "KATIE",
"middle_name": "ROSE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-05",
"last_updated": "2025-12-17",
"certification_date": "2025-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "10100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.