NPIMap

Organization Active NPI

DRS. Harrison & Ryan - Peters Creek Dentistry, PLLC

Doing business as Peters Creek Family Dentistry

  • Dentist
  • Roanoke, VA
National Provider Identifier
1770249757
Registry record updated Nov 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DRS. HARRISON & RYAN - PETERS CREEK DENTISTRY, PLLC
Doing business as
Peters Creek Family Dentistry
Practice address
2945 Peters Creek Rd NW
Roanoke, VA 24019-3513
Phone
(540) 562-4001
NPI assigned
Nov 13, 2021
Last updated
Nov 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2021

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

Authorized official

Name
Chad Hendricks
Title
Credentialing
Phone
(612) 859-0444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

2945 Peters Creek Rd NW
Roanoke, VA 24019-3513

Mailing address

2945 Peters Creek Rd NW
Roanoke, VA 24019-3513
Phone (540) 562-4001

Other names 1

  • Peters Creek Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2945 Peters Creek Rd NW
Roanoke, VA 24019
Phone (540) 562-4001

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1636761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636761600000",
    "number": "1770249757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 PETERS CREEK RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240193513",
            "telephone_number": "540-562-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 PETERS CREEK RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240193513",
            "telephone_number": "540-562-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. HARRISON & RYAN - PETERS CREEK DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-13",
        "last_updated": "2021-11-13",
        "certification_date": "2021-11-13",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peters Creek Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2021; 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.