Individual provider Active NPI

Timothy Burnette Naomi, D.D.S.

  • General Practice Dentistry
  • Louisville, KY
National Provider Identifier
1861442071
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE60857601 Issued in WA
Practice address
501 S Preston St
Louisville, KY 40202-1701
Phone
(028) 525-8385
NPI assigned
May 10, 2006
Last updated
Mar 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6597 NC
General Practice Dentistry 1223G0001X 11061 KY
General Practice Dentistry 1223G0001X DEN5340 ME
General Practice Dentistry 1223G0001X DE60857601 WA Primary

Addresses

Primary practice location

501 S Preston St
Louisville, KY 40202-1701

Mailing address

PO Box 421
Liberty Lake, WA 99019-0421
Phone (866) 747-2455

Other practice location 1

1048 Union St
Bangor, ME 04401-3016
Phone (207) 992-2152

Other identifiers 1

IdentifierTypeStateIssuer
89902MWMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241101002544 KY Practitioner - Dentist 5597720060 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6597NCMDProfessional Counselor
11061KYMDGeneral Practice Dentistry
DEN5340MEMDGeneral Practice Dentistry
DE60857601WAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville CurrentSince Oct 1, 2024 Accepting new patients
University of Louisville General Practice CurrentSince Oct 1, 2024 Accepting new patients

Locations

501 S Preston St
Louisville, KY 40202
Phone (502) 852-5096

501 S Preston St
Rm 48
Louisville, KY 40202
Phone (502) 852-2621

550 S Jackson St
Louisville, KY 40202
Phone (502) 561-8686

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1861442071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190421",
            "telephone_number": "866-747-2455",
            "fax_number": "509-227-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S PRESTON ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021701",
            "telephone_number": "028-525-8385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1048 Union St",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044013016",
            "country_code": "US",
            "telephone_number": "207-992-2152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAOMI",
        "first_name": "TIMOTHY",
        "middle_name": "BURNETTE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6597",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "11061",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN5340",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60857601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902MW",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.