Provider Demographics
NPI:1629296009
Name:POTIAN, CATHLEEN R (DMD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:R
Last Name:POTIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:VERNON COLONIAL PLAZA
Mailing Address - City:MC AFEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07428-1410
Mailing Address - Country:US
Mailing Address - Phone:973-209-4944
Mailing Address - Fax:973-209-1309
Practice Address - Street 1:VERNON COLONIAL PLAZA
Practice Address - Street 2:40 RT 94
Practice Address - City:MCAFEE
Practice Address - State:NJ
Practice Address - Zip Code:07428
Practice Address - Country:US
Practice Address - Phone:973-209-4944
Practice Address - Fax:973-209-1309
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02277100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist