Provider Demographics
NPI:1760899553
Name:JOHN L. POTTER, DMD PC
Entity Type:Organization
Organization Name:JOHN L. POTTER, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:610-433-2300
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:STE 2800
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4812
Mailing Address - Country:US
Mailing Address - Phone:610-433-2300
Mailing Address - Fax:610-433-4592
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:STE 2800
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4812
Practice Address - Country:US
Practice Address - Phone:610-433-2300
Practice Address - Fax:610-433-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSL028897L292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory