Healthcare Provider Details

I. General information

NPI: 1922499532
Provider Name (Legal Business Name): MRS. BECKY LYN POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST SUITE 202 SUMMIT DENTAL
CONCORD NH
03301
US

IV. Provider business mailing address

248 PLEASANT ST. SUITE 202 SUMMIT DENTAL
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7878
  • Fax:
Mailing address:
  • Phone: 603-228-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number02896
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: