Provider Demographics
NPI:1972561785
Name:POTEE, CHRISTOPHER W (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:POTEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1432
Mailing Address - Country:US
Mailing Address - Phone:317-776-0105
Mailing Address - Fax:317-776-0348
Practice Address - Street 1:340 LOGAN ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1432
Practice Address - Country:US
Practice Address - Phone:317-776-0105
Practice Address - Fax:317-776-0348
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120092611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN317010Medicare ID - Type Unspecified