Provider Demographics
NPI:1659630432
Name:POTASHNIKOVA, MARGARITA (DDS)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:POTASHNIKOVA
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 1:520 WEST AVE APT 705
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6797
Mailing Address - Country:US
Mailing Address - Phone:646-824-4006
Mailing Address - Fax:
Practice Address - Street 1:20401 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6794
Practice Address - Country:US
Practice Address - Phone:646-824-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01601197271223P0221X
FLDN264811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry