Active NPI
Karen Marise Petrella, DDS
- General Practice Dentistry
- Marietta, GA
National Provider Identifier
1629147699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 046332-1
- Practice address
- 1000 Halsey Ave
NBHC Nas Atlanta
Marietta, GA 30060 - Phone
- (678) 655-5317
- NPI assigned
- Nov 6, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 046332-1 | NY | Primary |
Addresses
Primary practice location
1000 Halsey Ave
NBHC Nas Atlanta
Marietta, GA 30060
Mailing address
2697 Catawba Dr NW
Kennesaw, GA 30152-6021
Phone (770) 424-1262
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 |
|---|---|---|---|
| 046332-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629147699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2697 CATAWBA DR NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301526021",
"telephone_number": "770-424-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 HALSEY AVE",
"address_2": "NBHC NAS ATLANTA",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30060",
"telephone_number": "678-655-5317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRELLA",
"first_name": "KAREN",
"middle_name": "MARISE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "046332-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
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.