Provider Demographics
NPI:1861466229
Name:POTTS, RICHARD R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:POTTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N TYLER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4900
Mailing Address - Country:US
Mailing Address - Phone:316-773-9200
Mailing Address - Fax:316-773-9205
Practice Address - Street 1:2121 N TYLER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4920
Practice Address - Country:US
Practice Address - Phone:316-773-9200
Practice Address - Fax:316-773-9205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice