Provider Demographics
NPI:1508859364
Name:POTTINGER, JENNIFER LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:POTTINGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 W 151ST STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-4800
Mailing Address - Country:US
Mailing Address - Phone:913-897-4300
Mailing Address - Fax:913-897-9505
Practice Address - Street 1:6885 W 151ST STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-4800
Practice Address - Country:US
Practice Address - Phone:913-897-4300
Practice Address - Fax:913-897-9505
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS70741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice