Provider Demographics
NPI:1386819167
Name:GEOFF POTTS, D.D.S.
Entity Type:Organization
Organization Name:GEOFF POTTS, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-447-5577
Mailing Address - Street 1:1020 24TH AVE., N.W.
Mailing Address - Street 2:STE. 101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-447-5577
Mailing Address - Fax:405-233-0028
Practice Address - Street 1:1020 24TH AVE NW
Practice Address - Street 2:STE. 101
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6341
Practice Address - Country:US
Practice Address - Phone:405-447-5577
Practice Address - Fax:405-233-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty