Jason Potrykus, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6388-15 Issued in WI

Practice address

213 Railroad St
Eagle River, WI 54521-8139

Phone

(715) 479-4686

Fax

(715) 479-5281

NPI assigned

Jun 10, 2009

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Potrykus Family Dentistry LLC

  • General Practice Dentistry
  • Eagle River, WI
  • NPI 1396870432
  NPD (past) GENERAL PRACTICE

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 10, 2009.

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244592000000",
    "number": "1124254644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1075",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545211075",
            "telephone_number": "715-479-4686",
            "fax_number": "715-479-5281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 RAILROAD ST",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545218139",
            "telephone_number": "715-479-4686",
            "fax_number": "715-479-5281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTRYKUS",
        "first_name": "JASON",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6388-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David William Peterson, RPH
• Jenna M Peterson, DPT
• Rebecca E Pflughoeft, NP
• Potrykus Family Dentistry LLC
• Ashley Marie Potrykus, NP
• Neal Potrykus, D.D.S.
• Redman & Gelinas SC
• Emily Rebecca Rhode, MS-CCC/SLP
• River North Pharmacy
• E Lanny Robins, MD

• All providers in Eagle River, WI
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.