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General NPI Number Information
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NPI Number | 1639669583
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Entity Type | Organization
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Legal Business Name | POTTER DDS, LLC
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 3145 LARIMER ST
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City | DENVER
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State | CO
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Zip | 80205-2312
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Country | US
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Telephone | 720-605-6502
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Fax |
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Provider Business Mailing Address
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Address Line | 3145 LARIMER ST
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City | DENVER
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State | CO
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Zip | 80205-2312
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Country | US
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Telephone | 720-605-6502
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOESEPH MATHEW POTTER
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Credential | DDS
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Telephone | 720-724-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN.00202685
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License Number State | CO
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