Provider Demographics
NPI:1669560009
Name:POTTI, MADHAVI (DDS)
Entity type:Individual
Prefix:DR
First Name:MADHAVI
Middle Name:
Last Name:POTTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 VILLAGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3007
Mailing Address - Country:US
Mailing Address - Phone:510-516-8009
Mailing Address - Fax:
Practice Address - Street 1:6400 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2448
Practice Address - Country:US
Practice Address - Phone:925-725-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51999122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist