Healthcare Provider Details

I. General information

NPI: 1457279630
Provider Name (Legal Business Name): KRYSTIN POTTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CHARLES H DIMMOCK PKWY STE 2
COLONIAL HEIGHTS VA
23834-2915
US

IV. Provider business mailing address

241 CHARLES H DIMMOCK PKWY STE 2
COLONIAL HEIGHTS VA
23834-2915
US

V. Phone/Fax

Practice location:
  • Phone: 804-575-0807
  • Fax:
Mailing address:
  • Phone: 804-575-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: