Active NPI
Jon Thaddeus Potocki, DDS
- Dentist
- Lexington, KY
National Provider Identifier
1053671768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9577
- Practice address
- 800 Rose St RM D104
Lexington, KY 40536-0297 - Phone
- (517) 281-9452
- NPI assigned
- May 29, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 9577 | KY | Primary |
Addresses
Primary practice location
800 Rose St RM D104
Lexington, KY 40536-0297
Mailing address
800 Rose St RM D104
Lexington, KY 40536-0297
Phone (517) 281-9452
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 |
|---|---|---|---|
| 9577 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1053671768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 ROSE ST RM D104",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405360297",
"telephone_number": "517-281-9452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 ROSE ST RM D104",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405360297",
"telephone_number": "517-281-9452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTOCKI",
"first_name": "JON",
"middle_name": "THADDEUS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-29",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "9577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.