Active NPI
Jonathan Bryan Petrie, DMD, MS
- Dentist
- Seminole, FL
National Provider Identifier
1851077309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DRPM2638
- Practice address
- 9200 113TH St
Seminole, FL 33772-2800 - Phone
- (727) 893-5050
- NPI assigned
- Jun 27, 2023
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DRPM2638 | FL | Primary |
Addresses
Primary practice location
9200 113TH St
Seminole, FL 33772-2800
Mailing address
6195 25TH Ave N
St Petersburg, FL 33710-4123
Phone (904) 238-0999
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 |
|---|---|---|---|
| DRPM2638 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1851077309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6195 25TH AVE N",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337104123",
"telephone_number": "904-238-0999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 113TH ST",
"city": "SEMINOLE",
"state": "FL",
"postal_code": "337722800",
"telephone_number": "727-893-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIE",
"first_name": "JONATHAN",
"middle_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "DMD, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-27",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DRPM2638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seminole, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.