Robert J Agnetta, DDS,MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DL-1766 Issued in ID

Practice address

22 Depot St Ste 17
Potsdam, NY 13676-1140

Phone

(315) 267-6588

NPI assigned

May 23, 2007

Last updated

Jan 22, 2016By the provider in NPPES

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453420800000",
    "number": "1437369154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 IVES ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014216",
            "telephone_number": "315-267-6588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 DEPOT ST STE 17",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761140",
            "telephone_number": "315-267-6588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGNETTA",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS,MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2016-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "DL-1766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "820505759",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Abbatematteo, MD
• Mazin Ismail Abdullah, M.D
• Aaron Gerald Acres, D.M.D.
• Joseph John Adams IV, FNP-C
• Lee Hartman Akin, D.D.S.
• Allan Jacobs MD PD (Market Street Anesthesia Associates)
• Alana Marie Alpert, ATC
• David F Amell, OD
• Caroline Arcand Dusseault

• Orthodontics and Dentofacial Orthopedics Dentistry in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; 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.