Active NPI
Dennis N. Domato, D.M.D.
- Dentist
- Louisville, KY
National Provider Identifier
1154426716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8069
- Practice address
- 12613 Taylorsville Rd
Suite 117
Louisville, KY 40299-4452 - Phone
- (502) 266-5355
- NPI assigned
- Sep 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8069 | KY | Primary |
Addresses
Primary practice location
12613 Taylorsville Rd
Suite 117
Louisville, KY 40299-4452
Mailing address
9529 Norton Commons Blvd
Prospect, KY 40059-7521
Phone (502) 425-1565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160720002473 | KY | Order and Referring Only - Dentist | 7214117159 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8069 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154426716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9529 NORTON COMMONS BLVD",
"city": "PROSPECT",
"state": "KY",
"postal_code": "400597521",
"telephone_number": "502-425-1565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12613 TAYLORSVILLE RD",
"address_2": "SUITE 117",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402994452",
"telephone_number": "502-266-5355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMATO",
"first_name": "DENNIS",
"middle_name": "N.",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "8069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.