Provider Demographics
NPI:1942337720
Name:POTENTCO MGMT CORP
Entity Type:Organization
Organization Name:POTENTCO MGMT CORP
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-687-0006
Mailing Address - Street 1:3111 45TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1974
Mailing Address - Country:US
Mailing Address - Phone:561-687-0006
Mailing Address - Fax:561-687-8611
Practice Address - Street 1:3111 45TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1974
Practice Address - Country:US
Practice Address - Phone:561-687-0006
Practice Address - Fax:561-687-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty