Healthcare Provider Details

I. General information

NPI: 1568091833
Provider Name (Legal Business Name): M. POTTI DDS MSD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 VILLAGE PKWY STE 100
DUBLIN CA
94568-3007
US

IV. Provider business mailing address

6400 VILLAGE PKWY STE 100
DUBLIN CA
94568-3007
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-2482
  • Fax:
Mailing address:
  • Phone: 510-248-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MADHAVI POTTI
Title or Position: PRESIDENT
Credential: DDS MSD
Phone: 925-248-2482