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General NPI Number Information
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NPI Number | 1053505602
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Entity Type | Individual
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Provider Name | STEPHEN STERLING POTTER DDS
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 90 HOPE DR BLDG 6000
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City | MOUNTAIN HOME AFB
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State | ID
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Zip | 83648-1062
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Country | US
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Telephone | 208-828-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 366 MDG 90 HOPE DRIVE
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City | MOUNTAIN HOME
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State | IDAHO
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Zip | 83648
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Country | UM
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Telephone |
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Fax |
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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 | 6632604-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6632604-9922
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License Number State | UT
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