Individual
DR. JON THADDEUS POTOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
800 ROSE ST RM D104, LEXINGTON, KY 40536-0297
(517) 281-9452
Mailing address
800 ROSE ST RM D104, LEXINGTON, KY 40536-0297
(517) 281-9452
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9577
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/29/2012
Last updated
03/22/2017
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