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General NPI Number Information
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NPI Number | 1740408004
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Entity Type | Organization
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Legal Business Name | MICHAEL L. POTTS, DDS, INC.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 445 ROSEWOOD AVE SUITE P
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City | CAMARILLO
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State | CA
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Zip | 93010-5929
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Country | US
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Telephone | 805-388-3319
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Fax | 805-388-0678
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Provider Business Mailing Address
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Address Line | 445 ROSEWOOD AVE SUITE P
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City | CAMARILLO
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State | CA
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Zip | 93010-5929
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Country | US
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Telephone | 805-388-3319
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Fax | 805-388-0678
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL L. POTTS
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Credential | DDS
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Telephone | 805-388-3319
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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 | 24905
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License Number State | CA
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