Raymond Wayne Petrunich, D.D.S.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

G1-001136 Issued in DE

Practice address

2444 Pulaski Hwy
#100
Newark, DE 19702-3906

Phone

(302) 836-3565

Fax

(302) 836-0868

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Petrunich Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Newark, DE
  • NPI 1548705197
  NPD (past) Authorized official

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483920000000",
    "number": "1649220526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2444 PULASKI HIGHWAY",
            "address_2": "#100",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023906",
            "telephone_number": "302-836-3565",
            "fax_number": "302-836-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2444 PULASKI HWY",
            "address_2": "#100",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023906",
            "telephone_number": "302-836-3565",
            "fax_number": "302-836-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUNICH",
        "first_name": "RAYMOND",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2017-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "DE",
            "license": "G1-001136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000014361",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Eileen Petrillo, NP
• Olga V Petrova, PA-C
• Renea Petrucci, PT, DPT
• Tara Petrucci
• Petrunich Oral Surgery
• Nicolle G Petticrew, B.A., CADC
• Raya Pezzillo, PA-C
• Patricia Pfeifer
• Yen Pham, PHARMD
• Patrick K Phelan, PAC

• Oral and Maxillofacial Pathology Dentistry in Newark, DE
• Providers in Newark, DE by specialty
• Oral and Maxillofacial Pathology Dentistry in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.