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General NPI Number Information
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NPI Number | 1942337720
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Entity Type | Organization
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Legal Business Name | POTENTCO MGMT CORP
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3111 45TH ST SUITE 7
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1974
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Country | US
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Telephone | 561-687-0006
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Fax | 561-687-8611
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Provider Business Mailing Address
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Address Line | 3111 45TH ST SUITE 7
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1974
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Country | US
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Telephone | 561-687-0006
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Fax | 561-687-8611
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL WESTCOTT
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Credential | DDS
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Telephone | 561-687-0006
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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 |
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License Number State | FL
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