Provider Demographics
NPI:1922178425
Name:POTEMPA AND CLOE DENTISTRY
Entity Type:Organization
Organization Name:POTEMPA AND CLOE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-680-1030
Mailing Address - Street 1:1216 AMERICAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3938
Mailing Address - Country:US
Mailing Address - Phone:847-680-1030
Mailing Address - Fax:847-680-1129
Practice Address - Street 1:1216 AMERICAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3938
Practice Address - Country:US
Practice Address - Phone:847-680-1030
Practice Address - Fax:847-680-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty