Vladimir Alexander Potepalov, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02284000 Issued in NJ

Practice address

74 Route 9
Unit C
Englishtown, NJ 07726-9209

Phone

(732) 972-7770

Fax

(732) 972-7705

NPI assigned

Feb 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8073/brand/1/csg/1/fhir/r4

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.

• Dental Star

  • Dental Clinic/Center
  • Manalapan, NJ
  • NPI 1942471586
  Authorized official Same address or phone
• Dental Star of New Jersey PC

  • General Practice Dentistry
  • Englishtown, NJ
  • NPI 1275183279
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306811492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 ROUTE 9",
            "address_2": "UNIT C",
            "city": "ENGLISHTOWN",
            "state": "NJ",
            "postal_code": "077269209",
            "telephone_number": "732-972-7770",
            "fax_number": "732-972-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 ROUTE 9",
            "address_2": "UNIT C",
            "city": "ENGLISHTOWN",
            "state": "NJ",
            "postal_code": "077269209",
            "telephone_number": "732-972-7770",
            "fax_number": "732-972-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTEPALOV",
        "first_name": "VLADIMIR",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02284000",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051368",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051368",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071331",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trevor Paul, PA-C
• Pediatric Dental Alliance LLP (My First Dentist)
• Pediatric Physician Care,LLC
• Phoenix Psychotherapy LLC
• Pinebrook Care Center Inc
• Powerback Rehabilitation LLC (Powerback Rehabilitation)
• Premier Behavioral Health Solutions, LLC
• Anita M Reeves, RN
• Remm Cognitive Training Inc.
• Ginnine Sue Ribolow, D.D.S.

• General Practice Dentistry in Englishtown, NJ
• Providers in Englishtown, NJ by specialty
• General Practice Dentistry in New Jersey

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.