Organization
DR. MARK POTHITAKIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK CHRIST POTHITAKIS D.D.S. (OWNER)
(319) 367-2311
Entity
Organization
Contact information
Practice address
107 E TOOTHACHE DR, NEW LONDON, IA 52645-1141
(319) 367-2311
Mailing address
107 E TOOTHACHE DR, NEW LONDON, IA 52645-1141
(319) 367-2311
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7584
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0086785
—
IA
01
—
831-776
PROVIDER MILITARY
IA
Enumeration date
05/22/2008
Last updated
05/22/2008
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