Potocki Pediatric Dentistry PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

POTOCKI PEDIATRIC DENTISTRY PLLC

Practice address

12365 E Michigan Ave
Grass Lake, MI 49240-8000

Phone

(517) 764-6283

NPI assigned

Apr 15, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Melisa Potocki, DMDNPI 1770996399

Title

Owner Dentist

Phone

(248) 361-1512

Specialties & licenses 1

Addresses

Other names 1

• Grass Lake Pediatric Dentistry and Orthodontics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melisa Gilbey Potocki, D.M.D.

  • Pediatric Dentistry
  • Marquette, MI
  • NPI 1770996399
  NPD Authorized official

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1831832039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12365 E MICHIGAN AVE",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492408000",
            "telephone_number": "517-764-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12365 E MICHIGAN AVE",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492408000",
            "telephone_number": "517-764-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOCKI PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-15",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "POTOCKI",
        "authorized_official_first_name": "MELISA",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "248-361-1512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grass Lake Pediatric Dentistry and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Holleigh Neff
• Thera Nichols
• Melissa O'Neill, MOT
• Julie Lynn Pariseau, RPH.
• Positive Mindset Therapy, LLC
• Providence Hospital
• Todd R. Raehtz, RPH
• Rachel Rice
• Sandra R Richards, N.P.
• Jayna Lynn Sharpley, RN

• All providers in Grass Lake, MI
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.