John Petkanas, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DI02019600 Issued in NJ

Practice address

777 Terrace Ave
Suite 302
Hasbrouck Heights, NJ 07604-3102

Phone

(201) 703-0100

Fax

(201) 703-0101

NPI assigned

Aug 20, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494201600000",
    "number": "1669587978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 TERRACE AVE",
            "address_2": "SUITE 302",
            "city": "HASBROUCK HEIGHTS",
            "state": "NJ",
            "postal_code": "076043102",
            "telephone_number": "201-703-0100",
            "fax_number": "201-703-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 TERRACE AVE",
            "address_2": "SUITE 302",
            "city": "HASBROUCK HEIGHTS",
            "state": "NJ",
            "postal_code": "076043102",
            "telephone_number": "201-703-0100",
            "fax_number": "201-703-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKANAS",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2017-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "DI02019600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Hasbrouck Heights, NJ
• Providers in Hasbrouck Heights, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.