Howard Paul Potocsky, D.D.S
Individual provider Active NPI General Practice Dentistry · Riverview, MI
NPI 1295731420 · NPPES record last updated Sep 10, 2007
Key facts
- NPI
- 1295731420
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 18547 (MI)
- Practice address
- 17128 Fort St
Riverview, MI 48192-6619 - Phone
- (734) 281-3200
- Fax
- (734) 281-3890
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 28, 2015 through Dec 28, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18547 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| GD Mi Riverview PLLC | General Practice | Past |
Accepting new patients |
| A Dental Center-Downriver | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18547 | MI | Yes |
Addresses
Primary practice location
17128 Fort St
Riverview, MI 48192-6619
Mailing address
17128 Fort St
Riverview, MI 48192-6619
Phone (734) 281-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J172880 | Other | MI | BLUE CROSS BLUE SHIELD |
| 4462818 | Medicaid | MI |
Other providers in Riverview, MI
- Perry Drug Stores Inc and Subsidiaries
- Susan C Perry
- Marcella Pertee
- Frances Conswayla Phillips
- Rodney H Poling
- Premier Urology PLLC
- Michael Thomas Prudhomme
- Pulmonary and Sleep Medicine PC
- Pulmonary Critical Care & Sleep Medicine PC
- Pulmonary Critical Care and Sleep Medicine
All providers in Riverview, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.