Paul M Kotuby Jr., D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DEN01874 Issued in RI

Practice address

15 Gooding Avenue, Suite 1
Bristol, RI 02809-2600

Phone

(401) 253-3781

Fax

(401) 253-9324

NPI assigned

Dec 11, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Bayside Dental Incorporated

  • Dentist
  • Bristol, RI
  • NPI 1942323621
  NPD (past) Authorized official

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

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260489600000",
    "number": "1336478882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 GOODING AVENUE, SUITE 1",
            "city": "BRISTOL",
            "state": "RI",
            "postal_code": "028092600",
            "telephone_number": "401-253-3781",
            "fax_number": "401-253-9324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 GOODING AVENUE, SUITE 1",
            "city": "BRISTOL",
            "state": "RI",
            "postal_code": "028092600",
            "telephone_number": "401-253-3781",
            "fax_number": "401-253-9324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTUBY",
        "first_name": "PAUL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-11",
        "last_updated": "2009-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "RI",
            "license": "DEN01874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BD-24695",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kristina Keddie, ATC, LAT
• Christopher F Kempf, ARNP
• Joshua Neil King, A.T.C.
• James C. Kovolyan II, PT
• John Labao
• Sarah Elizabeth Flinn Larson, MS, RD, LDN
• Lepre Physical Therapy of Bristol, LLC
• Susan Helen Levesque-Degrazia, RPH

• Dentist in Bristol, RI
• Providers in Bristol, RI by specialty
• Dentist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.