DENNIS G PETTIT DDS INC (NPI# 1356667323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356667323 |
| Entity Type | Organization |
| Organization Name | DENNIS G PETTIT DDS INC |
| Practice Address |
1762 Commerce Center Blvd Fairborn OH 45324-6358 |
| Practice Telephone | 9378788694 |
| Mailing Telephone | 9378788694 |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2010-04-23 |
| Authorized Official Name | DR. DENNIS G. PETTIT (OWNER/PROVIDER) |
| Authorized Official Telephone | 9378788694 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
30-01-8161 | OH | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0695609 | 05 |
| Street Address |
1762 COMMERCE CENTER BLVD |
| City | FAIRBORN |
| State | OH |
| Zip Code | 45324-6358 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356354765 | Dennis G Pettit | Dentist | 1762 Commerce Center Blvd, Fairborn, OH 45324-6358 | 2006-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023647591 | Michael Hubbell | Student in an Organized Health Care Education/Training Program | 2555 University Blvd., Fairborn, OH 45324 | 2020-04-06 |
| 1982243382 | Wickshire Fairborn Opco LLC | Assisted Living Facility | 2270 Park Hills Drive, Fairborn, OH 45324 | 2020-01-02 |
| 1104301654 | Sophia Alridge | Counselor | 594 East Dayton Yellow Springs Road, Fairborn, OH 45324 | 2018-10-01 |
| 1750863189 | Sydney Bowser | Behavior Technician | 1750 Commerce Center Blvd., Fairborn, OH 45324 | 2018-09-01 |
| 1710406798 | Chester Cashmir Torkornoo | Dentist | 3989 Colonel Glenn Hwy A, Fairborn, OH 45324 | 2017-09-11 |
| 1245772375 | Ranada LLC | Health Maintenance Organization | 17 Vanderbilt Drive Apt G, Fairborn, OH 45324 | 2016-11-07 |
| 1194277582 | Derrick Bark | Specialist/Technologist | 85 Old Yellow Springs Rd, Fairborn, OH 45324 | 2016-11-01 |
| 1326592635 | Sheena Elizabeth Geoghegan | Student in an Organized Health Care Education/Training Program | 725 Univerisity Blvd., Wright State Physicians, Fairborn, OH 45324 | 2016-08-04 |
| 1912360199 | Tarah Heath | Occupational Therapist | 2498 Dayton, Beavercreek, OH 45324 | 2016-04-04 |
| 1255706339 | Cierra Jackson | Counselor | 1560 Calder Ct, Fairborn, OH 45324 | 2015-12-01 |
| Find all providers in zip 45324 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073855193 | Buckeye Oral & Maxillofacial Surgey | Clinic/Center | 110 Polaris Parkway, Suite 110, Westerville, OH 43082-0000 | 2013-03-27 |
| 1588131528 | James A Maxwell Jr Dds, Inc | Clinic/Center | 2210 Olympic St, Springfield, OH 45503-2737 | 2018-10-29 |
| 1013450014 | Muskingum Valley Oral Surgery, Inc. | Clinic/Center | 7297 John Glenn Hwy, Cambridge, OH 43725-9034 | 2016-11-22 |
| 1164854774 | Comprehensive Oral & Maxillofacial Surgery Center | Clinic/Center | 5319 Meadow Lane Ct, Sheffield Village, OH 44035-1469 | 2013-08-06 |
| 1508209446 | Nationwide Children's | Clinic/Center | 700 Childrens Dr, Columbus, OH 43205-2664 | 2013-04-10 |
| 1760723902 | Case School of Dental Medicine | Clinic/Center | 2124 Cornell Rd, Cleveland, OH 44106-3804 | 2013-03-13 |
| 1083907539 | Brian C. Weaver, Dds, LLC | Clinic/Center | 627 Office Pkwy, Suite B, Westerville, OH 43082-7988 | 2011-05-17 |
| 1427383272 | Western Reserve Center for Orofacial and Cosmetic Surgery | Clinic/Center | 14700 Detroit Ave, Lakewood, OH 44107-4116 | 2009-10-13 |
| 1700027042 | Kenneth J Molnar Dds Inc | Clinic/Center | 2191 Park Ave W, Mansfield, OH 44906-1226 | 2009-03-17 |
| 1861663106 | Center for Oral and Maxillofacial Surgery | Clinic/Center | 28871 Center Ridge Rd, Suite 104, Westlake, OH 44145-5271 | 2008-03-14 |
| 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.