Active NPI
Daniel J Petrocella, DDS, PA
- General Practice Dentistry
- Raleigh, NC
National Provider Identifier
1922143783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6253
- Practice address
- 4551 New Bern Ave
Raleigh, NC 27610-1551 - Phone
- (919) 231-6024
- Fax
- (919) 231-8121
- NPI assigned
- Feb 20, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6253 | NC | Primary |
Addresses
Primary practice location
4551 New Bern Ave
Raleigh, NC 27610-1551
Mailing address
3060 Granville Dr
Raleigh, NC 27609-6918
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6253 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922143783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3060 GRANVILLE DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276096918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4551 NEW BERN AVE",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276101551",
"telephone_number": "919-231-6024",
"fax_number": "919-231-8121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROCELLA",
"first_name": "DANIEL",
"middle_name": "J",
"credential": "DDS, PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "6253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.