Phil Potempa, DDS

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

DN17474 Issued in FL

Practice address

1100 Loveland Blvd
Port Charlotte, FL 33980

Phone

(941) 624-7200

Fax

(941) 624-7274

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481846400000",
    "number": "1811099062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 LOVELAND BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33980",
            "telephone_number": "941-624-7200",
            "fax_number": "941-624-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LOVELAND BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33980",
            "telephone_number": "941-624-7200",
            "fax_number": "941-624-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTEMPA",
        "first_name": "PHIL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2016-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "FL",
            "license": "DN17474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02792420411",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "076162100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR LICENSE",
            "identifier": "P351679422910",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Port Charolette Alf, LLC
• Julie Kay Porter Kern, OD
• Porter Radiation Oncology PA
• Lorena E Posligua, MD
• Barbara Poteat-Gill
• Chris Eric Potter, FNP-BC
• Kimberly Pouk
• Neil Garrett Powell Jr., MD
• Mark Prebonich, M.D.
• Precision Medical Imaging

• Public Health Dentistry in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Public Health Dentistry in Florida

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