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General NPI Number Information
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NPI Number | 1265809644
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Entity Type | Organization
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Legal Business Name | FRED H POTTER, DDS
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 601 S BOWIE DR
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City | WEATHERFORD
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State | TX
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Zip | 76086-5138
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Country | US
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Telephone | 817-594-8761
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Fax | 817-594-0028
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Provider Business Mailing Address
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Address Line | 601 S BOWIE DR
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City | WEATHERFORD
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State | TX
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Zip | 76086-5138
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Country | US
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Telephone | 817-594-8761
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Fax | 817-594-0028
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Authorized Official
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Title or Position | OWNER
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Name | BETH POTTER
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Credential |
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Telephone | 817-613-7775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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