Provider Demographics
NPI:1437419264
Name:POTTS, KRISTEN R (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:R
Last Name:POTTS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:5720 WINDMERE LN
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2666
Mailing Address - Country:US
Mailing Address - Phone:817-975-9446
Mailing Address - Fax:817-887-1705
Practice Address - Street 1:5720 WINDMERE LN
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76137-2666
Practice Address - Country:US
Practice Address - Phone:817-975-9446
Practice Address - Fax:817-887-1705
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03689124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNONE ISSUEDOtherNONE ISSUED