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Deactivated NPI 1114253705 Deactivated / Inactive NPI Male Practitioner

Dr. James Gerald Pettey , DDS

Dentist - General Practice • Riverside, CA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. James Pettey has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 02, 2009
NPI Deactivation Date January 04, 2018
Total Practice Duration ~9 Years of Practice (2009 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. James Pettey, DDS was a registered Dentist - General Practice practicing in Riverside, CA. Throughout an active medical career spanning 9 years, Dr. Pettey provided care at the practice location at 6859 MAGNOLIA AVE until profile deactivation on 2018-01-04.

Practice Location & Contact Primary Location

Practice Address

6859 Magnolia Ave
Suite 2

Riverside, CA 92506

Telephone 9516820810
Fax 9517840888
Associated Practice Facility / Clinic
🏢 Young Kim Dental Corp Facility NPI 1164922134

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Riverside, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 21.7 Yrs
Regional Practice Density
186 Specialists

Practicing in Riverside, CA (18734 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CA 24907

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1497082937

Doctor of Dental Surgery

Dr. Gina Kim , DDS

Dentist - General Practice

NPI 1528802840

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 04, 2018

Record deactivated on January 04, 2018

NPI Profile Active November 02, 2009

NPI status registered as active in NPPES database

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Updated Practice Location November 02, 2009

Registered at 6859 MAGNOLIA AVE, SUITE 2, RIVERSIDE, CA 92506 (Tel: 9516820810)

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Updated Business Mailing Address November 02, 2009

Registered at 6859 MAGNOLIA AVE, SUITE 2, RIVERSIDE, CA 92506 (Tel: 9516820810)

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Provider Name / Credentials Updated November 02, 2009

Recorded as JAMES PETTEY, D.D.S

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 02, 2009

Dentist (License #24907 in CA)

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Initial NPI Registration & Enumeration November 02, 2009

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114253705
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 02, 2009
Last Update: November 02, 2009
Deactivation Date: January 04, 2018

Mailing Address

6859 Magnolia Ave, Suite 2

Riverside, CA 92506

Phone: 9516820810

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.