Potter, Kevin Clyde

Potter, Kevin Clyde is an individual health care provider with primary practice located at 1804 Warden St , Eau Claire WI 54703. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Potter, Kevin Clyde can be contacted via phone (715) 834-8484.

Contact Information

Primary practice address
1804 Warden St Eau Claire WI 54703
Phone: (715) 834-8484
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 3070015 Wisconsin

Profile Details

NPI number 1891751582
LBN Legal business name Potter, Kevin Clyde
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 22nd, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891751582 NPPES
Wisconsin MEDICAID 33447500

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