Provider Demographics
NPI:1295836153
Name:POTTER, STEVEN WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
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 1:921 E FM 1187
Mailing Address - Street 2:SUITE A
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-2600
Mailing Address - Country:US
Mailing Address - Phone:817-297-9838
Mailing Address - Fax:
Practice Address - Street 1:921 EAST FM 1187
Practice Address - Street 2:SUITE A
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-2600
Practice Address - Country:US
Practice Address - Phone:817-297-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics