Individual
JASON POTRYKUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
213 RAILROAD ST, EAGLE RIVER, WI 54521-8139
(715) 479-4686
(715) 479-5281
Mailing address
PO BOX 1075, EAGLE RIVER, WI 54521-1075
(715) 479-4686
(715) 479-5281
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6388-15
WI
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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