Provider Demographics
NPI:1649590894
Name:DAWN POTTER, LLC
Entity type:Organization
Organization Name:DAWN POTTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DIPL OM
Authorized Official - Phone:727-475-4710
Mailing Address - Street 1:2916 STAR APPLE CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3618
Mailing Address - Country:US
Mailing Address - Phone:727-475-4710
Mailing Address - Fax:
Practice Address - Street 1:2907 STATE ROAD 590 STE 6A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2505
Practice Address - Country:US
Practice Address - Phone:727-475-4710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1972261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center