Individual provider Active NPI

Jeffrey E Perrero, D.M.D.

  • Dentist
  • Phoenix, AZ
National Provider Identifier
1679892640
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D009517 Issued in AZ
Practice address
4501 N 7TH St
Phoenix, AZ 85014-3804
Phone
(602) 845-5730
NPI assigned
May 28, 2010
Last updated
Dec 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D009517 AZ Primary
General Practice Dentistry 1223G0001X 7684117-9922 UT

Addresses

Primary practice location

4501 N 7TH St
Phoenix, AZ 85014-3804

Mailing address

4501 N 7TH St
Phoenix, AZ 85014-3804
Phone (602) 845-5730

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20160115000676 UT Order and Referring Only - DentistPractitioner - Dentist 8426351909

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D009517AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Central Dental Partners LLC General Practice PastSince Feb 18, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1275004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1679892640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 N 7TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850143804",
            "telephone_number": "602-845-5730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 N 7TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850143804",
            "telephone_number": "602-845-5730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRERO",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-28",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D009517",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7684117-9922",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.