Provider Demographics
NPI:1568471233
Name:POTTER, JOE W (DDS)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:W
Last Name:POTTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOE
Other - Middle Name:W
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:815 KNOLL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-7807
Mailing Address - Country:US
Mailing Address - Phone:972-291-1501
Mailing Address - Fax:972-291-1503
Practice Address - Street 1:207 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2066
Practice Address - Country:US
Practice Address - Phone:972-291-1501
Practice Address - Fax:972-291-1503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0387OtherBLUE CROSS AND BLUE SHIEL