NPIMap

Organization Active NPI

Karen Y. Petty, DDS, PA

  • Dentist
  • Raleigh, NC
National Provider Identifier
1669644282
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6633 Issued in NC
Legal business name
KAREN Y. PETTY, DDS, PA
Practice address
310 W Millbrook Rd
Suite 100
Raleigh, NC 27609-4306
Phone
(919) 875-1630
Fax
(919) 875-1629
NPI assigned
Mar 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

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

Authorized official

Name
Dr. Karen Petty, DDSNPI 1164509402
Title
Dentist
Phone
(919) 875-1630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 6633 NC Primary

Addresses

Primary practice location

310 W Millbrook Rd
Suite 100
Raleigh, NC 27609-4306

Mailing address

310 W Millbrook Rd
Suite 100
Raleigh, NC 27609-4306
Phone (919) 875-1630

Other identifiers 3

IdentifierTypeStateIssuer
899016EOtherNCBCBS
899016EMedicaidNC
8996848MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Karen Y Petty DDS PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

310 W Millbrook Rd
Ste 100
Raleigh, NC 27609
Phone (919) 875-1630

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1669644282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W MILLBROOK RD",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094306",
            "telephone_number": "919-875-1630",
            "fax_number": "919-875-1629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W MILLBROOK RD",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276094306",
            "telephone_number": "919-875-1630",
            "fax_number": "919-875-1629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAREN Y. PETTY, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "919-875-1630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "6633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "899016E",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899016E",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8996848",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; 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.