Lisa Christine Petrov, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

20368 Issued in OH

Practice address

1212 North Abbe Rd Ste C
Elyria, OH 44035-1649

Phone

(440) 366-5530

Fax

(440) 366-5211

NPI assigned

Nov 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Enrolled in OH

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nelson M Petrov DDS Inc

  • Endodontics
  • Elyria, OH
  • NPI 1306911631
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962577296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 NORTH ABBE RD STE C",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440351649",
            "telephone_number": "440-366-5530",
            "fax_number": "440-366-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 NORTH ABBE RD STE C",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440351649",
            "telephone_number": "440-366-5530",
            "fax_number": "440-366-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROV",
        "first_name": "LISA",
        "middle_name": "CHRISTINE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OH",
            "license": "20368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abraham O Pedro, MD
• Elba Perez
• Jerome Lee Perkins
• Jonathan Perry
• Debora Petani, PA-C
• Nelson Mark Petrov, DDS
• Erin Nicole Phillips, M.A., L.P.C
• Jason Matthew Phillips, MH COUNSELOR INTERN
• Sharvelle Phillips
• William Phillips

• Endodontics in Elyria, OH
• Providers in Elyria, OH by specialty
• Endodontics in Ohio

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.