Provider Demographics
NPI:1740408004
Name:MICHAEL L. POTTS, DDS, INC.
Entity Type:Organization
Organization Name:MICHAEL L. POTTS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-388-3319
Mailing Address - Street 1:445 ROSEWOOD AVE
Mailing Address - Street 2:SUITE P
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5929
Mailing Address - Country:US
Mailing Address - Phone:805-388-3319
Mailing Address - Fax:805-388-0678
Practice Address - Street 1:445 ROSEWOOD AVE
Practice Address - Street 2:SUITE P
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5929
Practice Address - Country:US
Practice Address - Phone:805-388-3319
Practice Address - Fax:805-388-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty