Dr. Nicholas Peretti, D.D.S.
Dentist, Oral and Maxillofacial Surgery in Maywood, IL. Individual provider (NPI-1).
NPI number1013301993
StatusActive
Last updated in NPPESJul 8, 2019
Details
- NPI
- 1013301993
- Entity type
- Individual (NPI-1)
- Name
- Dr. Nicholas Peretti
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 27, 2015
- Last updated
- Jul 8, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- Medicare opt-out
- Apr 14, 2025 to Apr 14, 2027
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 17106 | MT | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
2160 S 1st AveBldg. 105 Suite 1814
Maywood, IL 60153-3328
Phone 888-584-7888
Mailing address
2160 S 1st AveMaywood, IL 60153-3328
Phone 888-584-7888
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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