DR. ERIC O PETTIT (NPI# 1124019088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124019088 |
| Entity Type | Individual |
| Full Name | DR. ERIC O PETTIT |
| Credential | DDS |
| Practice Address |
4820 West Taft Road Suite 204 Liverpool NY 13088 |
| Practice Telephone | 3154572011 |
| Mailing Telephone | 3154572011 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
0246409 | NY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00562249 | 05 |
| Street Address |
4820 WEST TAFT ROAD SUITE 204 |
| City | LIVERPOOL |
| State | NY |
| Zip Code | 13088 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962824805 | Carolyn Lee Adams | Nurse Practitioner | 4820 West Taft Road, Suite 108, Liverpool, NY 13088 | 2014-01-13 |
| 1023310364 | Peter J Moses | Dentist | 4820 West Taft Road, Suite 214, Liverpool, NY 13088 | 2010-11-18 |
| 1295889624 | Paul Joseph Longo | Dentist | 4820 West Taft Road, Liverpool, NY 13088 | 2007-01-23 |
| 1821168188 | Joseph S Tutor | Dentist | 4820 West Taft Road, Suite 101 West Taft Medical Park, Liverpool, NY 13088 | 2006-11-08 |
| 1639252422 | Deborah Jean Freeman | Nurse Practitioner | 4820 West Taft Road, Ste 108, Liverpool, NY 13088 | 2006-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878966 | Anthony Edward Blumetti | Psychologist | 5100 W. Taft Road, Suite 3b, Liverpool, NY 13088 | 2019-12-12 |
| 1609350016 | Alice Nellenbach | Physical Therapy Assistant | 346 Electronics Pkwy, Liverpool, NY 13088 | 2018-09-20 |
| 1043741457 | Dawn Marie Thomas | Licensed Practical Nurse | 212 Old Liverpool Road, Building 7 Apartment 6, Liverpool, NY 13088 | 2017-03-27 |
| 1154775633 | Arielle L Leonard | Massage Therapist | 609 7th N. Street, Suite 2, Liverpool, NY 13088 | 2016-04-20 |
| 1942664362 | Accessibility Solutions, Inc. | Contractor | 115 Luther Avenue, Liverpool, NY 13088 | 2016-04-12 |
| 1497176333 | Sergey Golovko | Psychiatry & Neurology | 125 Sun Harbor Dr, Liverpool, NY 13088 | 2013-12-19 |
| 1205275286 | Brandon William Crandall | Nurse Practitioner | 5100 West Taft Rd., Suite 1c, Liverpool, NY 13088 | 2013-06-23 |
| 1184976805 | Audrey Irene Tyszka | Social Worker | 5100 W Taft Rd Ste 1f, Liverpool, NY 13088 | 2012-10-04 |
| 1790049096 | Kelley Beth Burt | Speech-Language Pathologist | 110 Elwood Davis Road, Liverpool, NY 13088 | 2012-07-02 |
| 1811288954 | Nedim Ruhotina | Urology | 100 Metropolitan Park Drive, Suite 100, Liverpool, NY 13088 | 2011-04-24 |
| Find all providers in zip 13088 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770924003 | Christopher Alan Rozhon | Dentist | 7282 Oswego Rd, Liverpool, NY 13090-3719 | 2013-07-15 |
| 1700946381 | Robert Douglas Willis | Dentist | 7282 Oswego Rd, Liverpool, NY 13090-3719 | 2006-12-12 |
| 1861552564 | Margaret Cameron Madonian | Dentist | 600 Oswego St, Liverpool, NY 13088-5178 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417557059 | Smiles and Grins Pediatric Dentistry | Dentist | 160 E 88th St Apt 1d, New York, NY 10128-2217 | 2020-10-30 |
| 1891395810 | Ez Orthodontics Pllc | Dentist | 4010 82nd St Fl 2, Elmhurst, NY 11373-1305 | 2020-10-28 |
| 1346858677 | Kids Dental of Queens PC | Dentist | 4236 82nd St # C, Elmhurst, NY 11373-3537 | 2020-07-22 |
| 1073131512 | Prohealth Dental Pllc | Dentist | 2318 31st St Ste 320, Astoria, NY 11105-2765 | 2020-07-10 |
| 1952929911 | Kiddsmiles Pediatric Dentistry 7 Pllc | Dentist | 263 Jericho Tpke, Floral Park, NY 11001-2146 | 2020-07-07 |
| 1376177782 | Pco Ortho LLC | Dentist | 3422 35th St, Long Island City, NY 11106-1268 | 2020-02-24 |
| 1033749916 | Yehuda Marciano Dds PC | Dentist | 932 Broadway Ste 1, Woodmere, NY 11598-1723 | 2020-01-20 |
| 1710521752 | Asnis Dental Pllc | Dentist | 800 N Broadway, Massapequa, NY 11758-2335 | 2019-11-02 |
| 1760026777 | Dr. Stephen A Festa-pediatric Dentistry Pllc | Dentist | 3755 76th St Bsmt Apt, Jackson Heights, NY 11372-6552 | 2019-11-01 |
| 1841849965 | Woodrow Little Smiles Family Dentistry P.C. | Dentist | 739 Woodrow Road, Staten Island, NY 10312 | 2019-09-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.