NPIMap

Organization Active NPI

Petrunich Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Newark, DE
National Provider Identifier
1548705197
Registry record updated Jan 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
1136 Issued in DE
Legal business name
PETRUNICH ORAL SURGERY
Practice address
2444 Pulaski Hwy # 100
Newark, DE 19702-3906
Phone
(302) 836-3565
Fax
(302) 836-0868
NPI assigned
Jan 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Raymond Petrunich, DDSNPI 1649220526
Title
Owner
Phone
(302) 690-8822

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 1136 DE Primary

Addresses

Primary practice location

2444 Pulaski Hwy # 100
Newark, DE 19702-3906

Mailing address

2444 Pulaski Hwy # 100
Newark, DE 19702-3906

National Provider Directory

National Provider Directory

Locations

2444 Pulaski Hwy
#100
Newark, DE 19702
Phone (302) 836-3565

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483574400000",
    "number": "1548705197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2444 PULASKI HWY # 100",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2444 PULASKI HWY # 100",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023906",
            "telephone_number": "302-836-3565",
            "fax_number": "302-836-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRUNICH ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "last_updated": "2017-01-05",
        "status": "A",
        "authorized_official_last_name": "PETRUNICH",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-690-8822",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "DE",
            "license": "1136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2017; 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.