Healthcare Provider Details

I. General information

NPI: 1538176300
Provider Name (Legal Business Name): JOHN L POTTER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 COLLEGE HEIGHTS BLVD. SUITE 2800
ALLENTOWN PA
18104
US

IV. Provider business mailing address

3131 COLLEGE HEIGHTS BLVD. SUITE 2800
ALLENTOWN PA
18104
US

V. Phone/Fax

Practice location:
  • Phone: 610-433-2300
  • Fax: 610-433-4592
Mailing address:
  • Phone: 610-433-2300
  • Fax: 610-433-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD5028897L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: