JACK M. DORKHOM, DMD, PLLC (NPI# 1659721025) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659721025 |
| Entity Type | Organization |
| Organization Name | JACK M. DORKHOM, DMD, PLLC |
| Other Organization Name | MEADOWGATE FAMILY DENTAL |
| Practice Address |
101 Sullys Trl Building 10, Suite 11 Pittsford NY 14534-4552 |
| Practice Telephone | 5855868895 |
| Mailing Telephone | 5855868895 |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2016-06-16 |
| Authorized Official Name | JACK M DORKHOM (MEMBER/OWNER) |
| Authorized Official Telephone | 5855868895 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
051194 | NY | Dental Providers |
| Other Name | Type Code |
|---|---|
| Meadowgate Family Dental | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | JACK M. DORKHOM, DMD, PLLC | 101 Sully's Trail, Building 10, Pittsford, Ny 14534 |
| Street Address |
101 SULLYS TRL BUILDING 10, SUITE 11 |
| City | PITTSFORD |
| State | NY |
| Zip Code | 14534-4552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134129844 | Jennifer E Vogt | Physical Therapist | 101 Sullys Trl, Building 20, Pittsford, NY 14534-4552 | 2005-07-22 |
| 1548692874 | Panzarella Physical Therapy P.C. | Clinic/Center | 101 Sullys Trl, Bldg 20, Suite 9, Pittsford, NY 14534-4552 | 2013-08-09 |
| 1942563119 | Anne Burns Leitten | Registered Nurse | 101 Sullys Trl, Bldg 20, Pittsford, NY 14534-4552 | 2012-06-21 |
| 1245463355 | Marti Clement Fausold-mowers | Counselor | 101 Sullys Trl, Meadowgate Building 10, Pittsford, NY 14534-4552 | 2009-08-24 |
| 1134328222 | Anthony L Ricci | Dentist | 101 Sullys Trl, Building 10, Pittsford, NY 14534-4552 | 2007-07-17 |
| 1235258021 | James David Kestenbaum | Psychologist | 101 Sullys Trl, Bldg. 10, Pittsford, NY 14534-4552 | 2007-03-29 |
| 1952454985 | Cara Leslie Regan | Psychologist | 101 Sullys Trl, Meadowgate Office Park Suite 10, Pittsford, NY 14534-4552 | 2007-01-21 |
| 1578614699 | Jane M Fisher | Social Worker | 101 Sullys Trl, Meadowgate Bldg. 10, Pittsford, NY 14534-4552 | 2007-01-16 |
| 1073529772 | Harold D Lesser | Psychiatry & Neurology | 101 Sullys Trl, B U I L D I N G 20, Pittsford, NY 14534-4552 | 2006-08-01 |
| 1255346904 | Neurology Consultants of Rochester | Psychiatry & Neurology | 101 Sullys Trl, Bldg 20, Pittsford, NY 14534-4552 | 2006-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588273882 | Arbor Health Inc | Nutritionist | 613 Pittsford Victor Rd, Pittsford, NY 14534 | 2020-07-23 |
| 1619448990 | Azita Anissi Dds | Dentist | 121 Sullys Trail Suite 1, Pittsford, NY 14534 | 2018-12-11 |
| 1831697309 | Meaza Teklemariam | Registered Nurse | 2 Pin Hook Lane, Pittsford, NY 14534 | 2018-01-30 |
| 1386099356 | Bryan Robert Harrison | Psychologist | 610 Pittsford Victor Rd, Pittsford, NY 14534 | 2016-04-27 |
| 1942677323 | Dr. Anthony L. Ricci, Dds | Dentist | 135 Sully's Trail Suite 1, Pittsford, NY 14534 | 2015-09-01 |
| 1164782132 | George Francis Walsh Jr. | Obstetrics & Gynecology | 16 Kerrygold Way, Pittsford, NY 14534 | 2012-05-23 |
| 1346531878 | Samantha Lynne Saccento | Massage Therapist | 135 Sully's Trail Suite 6, Pittsford, NY 14534 | 2011-05-02 |
| 1093027252 | Brandon James Erdle | Dermatology | 6 Rambling Woods, Pittsford, NY 14534 | 2010-07-05 |
| 1760711576 | Finger Lakes Infectious Diseases, Pllc | Internal Medicine | 10 Brakenberry Road, Pittsford, NY 14534 | 2009-12-08 |
| 1477789030 | Mary Lou Testa | Counselor | 20 Tobey Village Way, Suite 7, Pittsford, NY 14534 | 2009-06-09 |
| Find all providers in zip 14534 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619448990 | Azita Anissi Dds | Dentist | 121 Sullys Trail Suite 1, Pittsford, NY 14534 | 2018-12-11 |
| 1942677323 | Dr. Anthony L. Ricci, Dds | Dentist | 135 Sully's Trail Suite 1, Pittsford, NY 14534 | 2015-09-01 |
| 1043531536 | Ihab Soliman | Dentist | 43 Coach Side Ln, Pittsford, NY 14534-9418 | 2010-06-18 |
| 1174723845 | Ronald Neil Heinle | Dentist | 740 Pittsford Victor Rd, Box 448, Pittsford, NY 14534-3938 | 2007-07-20 |
| 1285855601 | Jan M. Piper-glasgow, Dmd PC | Dentist | 40 Grove St # B, Pittsford, NY 14534-1317 | 2007-05-02 |
| 1134270275 | Kenneth R. Tirone | Dentist | 15 Fishers Rd, Suite 115, Pittsford, NY 14534-9544 | 2007-01-16 |
| 1396836557 | Pittsford Family Dental Practice P.C. | Dentist | 3592 Monroe Ave, Pittsford, NY 14534-1235 | 2006-09-27 |
| 1639279961 | Robert Jed Fox | Dentist | 157 W Jefferson Rd, Pittsford, NY 14534-1918 | 2006-09-25 |
| 1578667085 | Mona Haleem | Dentist | 24 Rensselaer Dr, Pittsford, NY 14534-3119 | 2006-09-13 |
| 1861416026 | Neil M Goldstein | Dentist | 30 Office Park Way, Tobey Village Office Park, Pittsford, NY 14534-1734 | 2006-07-27 |
| Find all providers in PITTSFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.