Jack M. Dorkhom, DMD, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

051194 Issued in NY

Legal business name

JACK M. DORKHOM, DMD, PLLC

Practice address

101 Sullys TRL
Building 10, Suite 11
Pittsford, NY 14534-4552

Phone

(585) 586-8895

NPI assigned

Jun 16, 2016

Organization subpart

No

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

Authorized official

Name

Jack M Dorkhom, D.M.D.

Title

Member/Owner

Phone

(585) 586-8895

Specialties & licenses 1

Addresses

Other names 1

• Meadowgate Family Dental Doing business as

Locations

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1659721025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SULLYS TRL",
            "address_2": "BUILDING 10, SUITE 11",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145344552",
            "telephone_number": "585-586-8895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SULLYS TRL",
            "address_2": "BUILDING 10, SUITE 11",
            "city": "PITTSFORD",
            "state": "NY",
            "postal_code": "145344552",
            "telephone_number": "585-586-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK M. DORKHOM, DMD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "DORKHOM",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "585-586-8895",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "051194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadowgate Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ellen Simon Irving, LCSW
• It Practice Consulting, Corp
• Antoinette H Jakobi, MD
• Jan M. Piper-Glasgow, DMD PC
• Carole I Jarvie
• Eddy S Jean-Baptiste, NURSING CARE,RN
• Christine M Jean-Jacques, PHD

• General Practice Dentistry in Pittsford, NY
• Providers in Pittsford, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.