Provider Demographics
NPI:1972643211
Name:POTT, THOMAS HARLAN (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HARLAN
Last Name:POTT
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 1:12600 W COLFAX AVE
Mailing Address - Street 2:SUITE B 160
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-3733
Mailing Address - Country:US
Mailing Address - Phone:303-237-0307
Mailing Address - Fax:303-202-9412
Practice Address - Street 1:12600 W COLFAX AVE
Practice Address - Street 2:SUITE B 160
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3733
Practice Address - Country:US
Practice Address - Phone:303-237-0307
Practice Address - Fax:303-202-9412
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice