Active NPI
Jack Michael Dorkhom, D.M.D.
- Dentist
- Pittsford, NY
National Provider Identifier
1184831109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 051194
- Practice address
- 101 Sully's TRL
Building 10
Pittsford, NY 14534 - Phone
- (585) 586-8895
- Fax
- (585) 485-0817
- NPI assigned
- May 17, 2007
- 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 | 051194 | NY | Primary |
Addresses
Primary practice location
101 Sully's TRL
Building 10
Pittsford, NY 14534
Mailing address
69A Monroe Ave
Pittsford, NY 14534-1321
Phone (585) 586-2580
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 |
|---|---|---|---|
| 051194 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canalside Dentistry PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Meadowgate Family Dental
- General Practice Dentistry
- Pittsford, NY
- NPI 1659721025
-
- Dentist
- Pittsford, NY
- NPI 1083910525
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711584000000",
"number": "1184831109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "69A MONROE AVE",
"city": "PITTSFORD",
"state": "NY",
"postal_code": "145341321",
"telephone_number": "585-586-2580",
"fax_number": "585-586-4924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 SULLY'S TRL",
"address_2": "BUILDING 10",
"city": "PITTSFORD",
"state": "NY",
"postal_code": "14534",
"telephone_number": "585-586-8895",
"fax_number": "585-485-0817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORKHOM",
"first_name": "JACK",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2024-03-28",
"certification_date": "2024-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "051194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pittsford, NY
- Kathleen M Dodsworth, DPM
- Donald Londorf MD PC
- Samantha Rose Donatello, LCSW
- David Richard Donnelly, BCBA
- Samantha Violet Donowski
- Tiffany Marie Double, LCSW
- Caley Dougherty, FNP
- Dr. Anthony L. Ricci, DDS
- Dr. Nicholas Holub, Evolve Psychological Services, PLLC
- Dr. Todd Deneen - Psychological Services, PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.