Active NPI
Jerek Bradford Petrous, D.D.S., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Madison Heights, MI
National Provider Identifier
1689016982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2901020512
- Practice address
- 30201 Dequindre Rd
Madison Heights, MI 48071-2284 - Phone
- (248) 219-4154
- Fax
- (248) 588-5610
- NPI assigned
- Jul 27, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2901020512 | MI | Primary |
Addresses
Primary practice location
30201 Dequindre Rd
Madison Heights, MI 48071-2284
Mailing address
30201 Dequindre Rd
Madison Heights, MI 48071-2284
Phone (248) 219-4154
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901020512 | MI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374883200000",
"number": "1689016982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30201 DEQUINDRE RD",
"city": "MADISON HEIGHTS",
"state": "MI",
"postal_code": "480712284",
"telephone_number": "248-219-4154",
"fax_number": "248-588-5610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30201 DEQUINDRE RD",
"city": "MADISON HEIGHTS",
"state": "MI",
"postal_code": "480712284",
"telephone_number": "248-219-4154",
"fax_number": "248-588-5610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROUS",
"first_name": "JEREK",
"middle_name": "BRADFORD",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-27",
"last_updated": "2013-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MI",
"license": "2901020512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison Heights, MI
- Mariuana Paynes, MS, LLP
- Gina Elizabeth Pearson, APRN, ANP-BC
- Samantha Kaur Sidhu Perdeep Singh Sidhu
- Sherria E Perry, CCHW
- Personalized Nursing Light House Inc (Male Residential)
- Kristofer Antonio Picano
- Kayla Alessandria Pilato
- Christopher Angelo Pilenza
- Gary L Pineau, CRNA
- Pleasant Rehab Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.