Active NPI
Dominique Petrone, DMD
- Dentist
- Port Saint Lucie, FL
National Provider Identifier
1750069704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28243
- Practice address
- 10670 SW Tradition Pkwy
Port Saint Lucie, FL 34987-2862 - Phone
- (772) 345-8332
- NPI assigned
- Jul 10, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 28243 | FL | Primary |
Addresses
Primary practice location
10670 SW Tradition Pkwy
Port Saint Lucie, FL 34987-2862
Mailing address
10280 SW Stephanie Way Unit 8201
Port Saint Lucie, FL 34987-1962
Phone (570) 401-5478
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28243 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688947200000",
"number": "1750069704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10280 SW STEPHANIE WAY UNIT 8201",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349871962",
"telephone_number": "570-401-5478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10670 SW TRADITION PKWY",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349872862",
"telephone_number": "772-345-8332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRONE",
"first_name": "DOMINIQUE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-10",
"last_updated": "2023-07-10",
"certification_date": "2023-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "28243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.