Michael Eric Kornblatt, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12012408A Issued in IN

Practice address

2917 E 10TH St
Jeffersonville, IN 47130-6916

Phone

(812) 284-2103

Fax

(812) 590-2077

NPI assigned

Apr 18, 2013

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

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1922442243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2917 E 10TH ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471306916",
            "telephone_number": "812-284-2103",
            "fax_number": "812-590-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2917 E 10TH ST",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471306916",
            "telephone_number": "812-284-2103",
            "fax_number": "812-590-2077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNBLATT",
        "first_name": "MICHAEL",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-18",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12012408A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Kociemba, PHARMD
• Ilana Kogan
• Sowmya Konakanchi, RPH
• Melissa Konijeti, MSW
• Clare Elizabeth Korleski
• Kort Rehabilitation at Home, LLC
• Sydni Kratz, LMHC
• Sarah Elizabeth Kremer, LPCA, MS
• Joanne Kristiansen, CRNA
• Kroger Limited Partnership I

• Pediatric Dentistry in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.