Provider Demographics
NPI:1467561571
Name:POTTS, DONALD LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LAWRENCE
Last Name:POTTS
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 1:6450 CENTERVILLE BUSINESS PKWY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2633
Mailing Address - Country:US
Mailing Address - Phone:937-435-9110
Mailing Address - Fax:937-435-0918
Practice Address - Street 1:6450 CENTERVILLE BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45459-2633
Practice Address - Country:US
Practice Address - Phone:937-435-9110
Practice Address - Fax:937-435-0918
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-85421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice