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General NPI Number Information
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NPI Number | 1053473637
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Entity Type | Individual
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Provider Name | KURT S POTACH DDS
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 607 1ST DR NW BOX 1064
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City | AUSTIN
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State | MN
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Zip | 55912-3072
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Country | US
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Telephone | 507-437-6312
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Fax | 507-437-4896
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Provider Business Mailing Address
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Address Line | 607 1ST DR NW BOX 1064
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City | AUSTIN
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State | MN
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Zip | 55912-3072
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Country | US
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Telephone | 507-437-6312
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Fax | 507-437-4896
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | MN8894
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License Number State | MN
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