Petra Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12458 Issued in MD

Legal business name

PETRA DENTISTRY LLC

Practice address

10910 Little Patuxent Pkwy
Suite 206
Columbia, MD 21044-3078

Phone

(410) 740-8588

Fax

(410) 740-9755

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Lara E Philippi, D.M.D.

Title

Dentist/Owner

Phone

(410) 740-8588

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598850422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10910 LITTLE PATUXENT PKWY",
            "address_2": "SUITE 206",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443078",
            "telephone_number": "410-740-8588",
            "fax_number": "410-740-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10910 LITTLE PATUXENT PKWY",
            "address_2": "SUITE 206",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210443078",
            "telephone_number": "410-740-8588",
            "fax_number": "410-740-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRA DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHILIPPI",
        "authorized_official_first_name": "LARA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "410-740-8588",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jolie Perzinski
• Peter Dexheimer PA
• Lara Jayne Peter, LCPC
• Nathaniel Peterson
• Raylee Peterson
• Terie Petrone, RN
• Alessia Giovanna Petroni
• Monica Petroski, PSY.D.
• Maria Antonette Petrucci, DC
• Dana Petry

• General Practice Dentistry in Columbia, MD
• Providers in Columbia, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.