John Joseph Petrini Jr., D.D.S, M.S.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

60724749 Issued in WA

Practice address

1111 Civic Dr
Suite 320
Walnut Creek, CA 94596-3895

Phone

(925) 935-4040

NPI assigned

Dec 13, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 23, 2018 through Oct 23, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590451200000",
    "number": "1679634679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 SW 155TH ST",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981662511",
            "telephone_number": "206-242-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CIVIC DR",
            "address_2": "SUITE 320",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945963895",
            "telephone_number": "925-935-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRINI",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S, M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "WA",
            "license": "60724749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Peterson
• Leah Taylor Peterson, AU.D.
• Linda Marie Peterson, CNM
• Marion Macphail Peterson, RN MFT
• Shannon Peterson, M.D.
• Nicole Ramos Petro, PA-C
• Stacey Elizabeth Petrowsky, MA, LMFT
• David Lewis Pfeifer
• Elizabeth Pfeiffer
• Jessica Rachel Pfisterer, AMFT

• Prosthodontics in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.