Ljubica Drina Petrasic Smith

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

56931 Issued in CA

Practice address

530 S Main St
Orange, CA 92868-4525

Phone

(714) 571-6431

NPI assigned

Oct 16, 2012

Sex

Female

Sole proprietor

No

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 Jul 15, 2016 through Jul 15, 2028

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1770836629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2836 DAISY LN",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953776694",
            "telephone_number": "209-834-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684525",
            "telephone_number": "714-571-6431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRASIC SMITH",
        "first_name": "LJUBICA",
        "middle_name": "DRINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Anne Peterson, CAODC
• Melanie Peterson, MD
• Shannon Shaffer Peterson, M.S.
• Terrye Peterson, RN, CDE
• Sahnvi Sunil Pethe
• Anton Petrenko, PHD
• Petri Dental Corporation
• John Adrian Petrie IV, MD
• Laura Emily Petrovich, MD
• Patricia Petrusan, RDH

• General Practice Dentistry in Orange, CA
• Providers in Orange, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; 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.