Provider Demographics
NPI:1306458377
Name:RONALD B POTTHOFF DDS
Entity type:Organization
Organization Name:RONALD B POTTHOFF DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-755-5280
Mailing Address - Street 1:195 COMMONS LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1912
Mailing Address - Country:US
Mailing Address - Phone:406-755-5280
Mailing Address - Fax:406-752-7679
Practice Address - Street 1:195 COMMONS LOOP STE A
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1912
Practice Address - Country:US
Practice Address - Phone:406-755-5280
Practice Address - Fax:406-752-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty