Provider Demographics
NPI:1356399836
Name:POTTER, BRAD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:POTTER
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:PO BOX 6510
Mailing Address - Street 2:MAIL STOP F742
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-0510
Mailing Address - Country:US
Mailing Address - Phone:720-848-0689
Mailing Address - Fax:720-848-0660
Practice Address - Street 1:1635 URSULA ST
Practice Address - Street 2:ROOM 5200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-7402
Practice Address - Country:US
Practice Address - Phone:720-848-0687
Practice Address - Fax:720-848-0660
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1045681223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology