Provider Demographics
NPI:1053473637
Name:POTACH, KURT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:S
Last Name:POTACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 1ST DR NW
Mailing Address - Street 2:BOX 1064
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3072
Mailing Address - Country:US
Mailing Address - Phone:507-437-6312
Mailing Address - Fax:507-437-4896
Practice Address - Street 1:607 1ST DR NW
Practice Address - Street 2:BOX 1064
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3072
Practice Address - Country:US
Practice Address - Phone:507-437-6312
Practice Address - Fax:507-437-4896
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN88941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice