Active NPI
Kathryn Petry, DDS
- General Practice Dentistry
- Anderson, IN
National Provider Identifier
1962664367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12011174A
- Practice address
- 4758 S Scatterfield Rd
Anderson, IN 46013-2908 - Phone
- (765) 642-9500
- Fax
- (765) 642-9910
- NPI assigned
- Jun 26, 2008
- Sex
- Female
- 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 | 12011174A | IN | Primary |
Addresses
Primary practice location
4758 S Scatterfield Rd
Anderson, IN 46013-2908
Mailing address
PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000
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 |
|---|---|---|---|
| 12011174A | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hagerstown Family Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Hagerstown, IN
- NPI 1306170345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214438400000",
"number": "1962664367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3189",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132203189",
"telephone_number": "315-454-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4758 S SCATTERFIELD RD",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460132908",
"telephone_number": "765-642-9500",
"fax_number": "765-642-9910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRY",
"first_name": "KATHRYN",
"name_prefix": "Ms.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-26",
"last_updated": "2008-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "12011174A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anderson, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.