Active NPI
Stephen Petty, D.D.S
- General Practice Dentistry
- El Paso, TX
National Provider Identifier
1871894907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 27160
- Practice address
- 6065 Montana Ave
El Paso, TX 79925-1835 - Phone
- (915) 771-7966
- NPI assigned
- Nov 5, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 27160 | TX | |
| General Practice Dentistry | 1223G0001X | 27160 | TX | Primary |
Addresses
Primary practice location
6065 Montana Ave
El Paso, TX 79925-1835
Mailing address
6065 Montana Ave
El Paso, TX 79925-1835
Phone (915) 771-7966
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 |
|---|---|---|---|
| 27160 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615248000000",
"number": "1871894907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6065 MONTANA AVE",
"city": "EL PASO",
"state": "TX",
"postal_code": "799251835",
"telephone_number": "915-771-7966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6065 MONTANA AVE",
"city": "EL PASO",
"state": "TX",
"postal_code": "799251835",
"telephone_number": "915-771-7966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "STEPHEN",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-11-05",
"last_updated": "2021-03-09",
"certification_date": "2021-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "27160",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "27160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.