Healthcare Provider Details

I. General information

NPI: 1518090547
Provider Name (Legal Business Name): BRITTANY LEIGH WEAVER POTTS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 MONROE ST SUITE 255
TOLEDO OH
43623-4385
US

IV. Provider business mailing address

4841 MONROE ST SUITE 255
TOLEDO OH
43623-4385
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-3100
  • Fax:
Mailing address:
  • Phone: 419-474-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.021993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: