Healthcare Provider Details

I. General information

NPI: 1669722310
Provider Name (Legal Business Name): DOROTHY F POTTS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 COUNTRY CLUB RD
GILFORD NH
03249-6978
US

IV. Provider business mailing address

PO BOX 7414
GILFORD NH
03247-7414
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-6460
  • Fax: 603-513-1813
Mailing address:
  • Phone: 603-524-6460
  • Fax: 603-513-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH563
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: