Provider Demographics
NPI:1356473342
Name:DISPONETT, JOHN PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:DISPONETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1869
Mailing Address - Country:US
Mailing Address - Phone:859-885-9577
Mailing Address - Fax:859-885-0431
Practice Address - Street 1:250 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1869
Practice Address - Country:US
Practice Address - Phone:859-885-9577
Practice Address - Fax:859-885-0431
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY68051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2112179OtherBC BS OF TN
KY6238OtherPASSPORT
KY60068053Medicaid