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General NPI Number Information
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NPI Number | 1609847342
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Entity Type | Individual
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Provider Name | DR. MICHAEL L. POTTER
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 8305 FALLS OF NEUSE RD SUITE 105
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City | RALEIGH
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State | NC
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Zip | 27615-3546
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Country | US
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Telephone | 919-841-1720
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Fax |
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Provider Business Mailing Address
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Address Line | 8305 FALLS OF NEUSE RD SUITE 105
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City | RALEIGH
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State | NC
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Zip | 27615-3546
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Country | US
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Telephone | 919-841-1720
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6451
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9024
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License Number State | NC
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