Active NPI
Kelly G. Pottorf, HYGIENST
- Dental Hygienist
- Saint Louis, MO
National Provider Identifier
1992008213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2009007073
- Practice address
- 1717 Biddle St
Saint Louis, MO 63106-3454 - Phone
- (314) 898-1717
- Fax
- (314) 814-8542
- NPI assigned
- Dec 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2009007073 | MO | Primary |
Addresses
Primary practice location
1717 Biddle St
Saint Louis, MO 63106-3454
Mailing address
1717 Biddle
St. Louis, MO 63107
Phone (314) 898-1717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2009007073 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009007073 | MO | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291766400000",
"number": "1992008213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 BIDDLE",
"city": "ST. LOUIS",
"state": "MO",
"postal_code": "63107",
"telephone_number": "314-898-1717",
"fax_number": "314-814-8542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 BIDDLE ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631063454",
"telephone_number": "314-898-1717",
"fax_number": "314-814-8542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTORF",
"first_name": "KELLY",
"middle_name": "G.",
"credential": "HYGIENST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-08",
"last_updated": "2010-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MO",
"license": "2009007073",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2009007073",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.