Healthcare Provider Details

I. General information

NPI: 1063682136
Provider Name (Legal Business Name): ROBERT M POTEAT DDS MS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 BULLARD COURT
RALEIGH NC
27615
US

IV. Provider business mailing address

1061 BULLARD COURT
RALEIGH NC
27615
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-0030
  • Fax: 919-876-2563
Mailing address:
  • Phone: 919-876-0030
  • Fax: 919-876-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3710
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT MCNEILL POTEAT
Title or Position: PRESIDENT
Credential: DDS MS PA
Phone: 919-876-0030