Healthcare Provider Details

I. General information

NPI: 1891897849
Provider Name (Legal Business Name): ROBERT MCNEILL POTEAT DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 BULLARD CT
RALEIGH NC
27615-6801
US

IV. Provider business mailing address

1061 BULLARD CT
RALEIGH NC
27615-6801
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:
Title or Position:
Credential:
Phone: