Provider Demographics
NPI:1962685289
Name:ANTHONY P. POTENTE, MS, DDS, APC
Entity Type:Organization
Organization Name:ANTHONY P. POTENTE, MS, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:POTENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-298-2291
Mailing Address - Street 1:4065 3RD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2184
Mailing Address - Country:US
Mailing Address - Phone:619-298-2291
Mailing Address - Fax:619-298-8504
Practice Address - Street 1:4065 3RD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2184
Practice Address - Country:US
Practice Address - Phone:619-298-2291
Practice Address - Fax:619-298-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty