Healthcare Provider Details

I. General information

NPI: 1225468812
Provider Name (Legal Business Name): KAREN POTACZEK, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 11TH ST SUITE 201
SPENCER IA
51301-4393
US

IV. Provider business mailing address

116 E 11TH ST SUITE 201
SPENCER IA
51301-4393
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-7350
  • Fax: 712-262-7351
Mailing address:
  • Phone: 712-262-7350
  • Fax: 712-262-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN POTACZEK
Title or Position: OWNER
Credential: D.D.S.
Phone: 712-262-7350