Active NPI
Ann B Petrillo, D.D.S.
- General Practice Dentistry
- Plymouth, PA
National Provider Identifier
1518096627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS-023131-L
- Practice address
- 580 E Main St
Plymouth, PA 18651-3123 - Phone
- (570) 779-5325
- Fax
- (570) 779-0793
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS-023131-L | PA | Primary |
Addresses
Primary practice location
580 E Main St
Plymouth, PA 18651-3123
Mailing address
580 E Main St
Plymouth, PA 18651-3123
Phone (570) 779-5325
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 |
|---|---|---|---|
| DS-023131-L | PA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1518096627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 E MAIN ST",
"city": "PLYMOUTH",
"state": "PA",
"postal_code": "186513123",
"telephone_number": "570-779-5325",
"fax_number": "570-779-0793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 E MAIN ST",
"city": "PLYMOUTH",
"state": "PA",
"postal_code": "186513123",
"telephone_number": "570-779-5325",
"fax_number": "570-779-0793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRILLO",
"first_name": "ANN",
"middle_name": "B",
"name_prefix": "Mrs.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS-023131-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, PA
- Debra Ann McDonald
- Tiffany Mae Michalek
- N.E.P.a Foot & Ankle Specialists P.C.
- Amanda Marie Naperski, MS, LAT, ATC, CES
- Abu Panackal, OTR/L
- Joseph Edmund Piszczek, MD
- Plymouth Borough Ambulance Assoc. Inc.
- Timothy Matthew Race, MSN, CRNP, PMHNP-BC
- Paul Michael Roan, B.S.
- Roans Prescription Drug Store
Sources for this page
- 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.