Provider Demographics
NPI:1053505602
Name:POTTER, STEPHEN STERLING (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:STERLING
Last Name:POTTER
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 1:86 MDG, UNIT 3215
Mailing Address - Street 2:APO, AE
Mailing Address - City:RAMSTEIN
Mailing Address - State:GERMANY
Mailing Address - Zip Code:09094-3215
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK AVENUE 66877
Practice Address - Street 2:
Practice Address - City:RAMSTEIN-MIESENBACH
Practice Address - State:GERMANY
Practice Address - Zip Code:66877
Practice Address - Country:DE
Practice Address - Phone:662-435-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6632604-99221223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053505602OtherFEDERAL SERVICES
MT1053505602OtherFEDERAL SERVICES