Mark M Petryna, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

NC6075 Issued in NC

Practice address

1348 Matthews Township Pkwy
Suite 101
Matthews, NC 28105

Phone

(704) 847-7799

Fax

(704) 849-7925

NPI assigned

Feb 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mark M. Petryna,D.D.S.,PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Matthews, NC
  • NPI 1528277217
  NPD (past) Authorized official

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629103494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1348 MATTHEWS TOWNSHIP PARKWAY",
            "address_2": "SUITE 101",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "28105",
            "telephone_number": "704-847-7799",
            "fax_number": "704-849-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 MATTHEWS TOWNSHIP PKWY",
            "address_2": "SUITE 101",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "28105",
            "telephone_number": "704-847-7799",
            "fax_number": "704-849-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRYNA",
        "first_name": "MARK",
        "middle_name": "M",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "NC6075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "476352",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "9705A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Personalized Therapy, Inc.
• Melissa Petcu
• Brenda Wright Peters, MS, CCC-SLP
• Luke Tyler Peterson, M.D.
• Alyssa Petruzzello
• Hiep Pham
• Christopher Latham Phelps, D.M.D.
• Richard John Phillips, PHARMD
• Thomas Hogeman Phillips, MD
• Sally Ray Pidge, SLP

• Oral and Maxillofacial Surgery (Dentist) in Matthews, NC
• Providers in Matthews, NC by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Carolina

• 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.