Organization
POTH FAMILY DENTAL, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN EVERETT POTH DDS (PRESIDENT)
(262) 692-2461
Entity
Organization
Contact information
Practice address
100 MARTIN DR, FREDONIA, WI 53021-9455
(262) 692-2461
(262) 692-9889
Mailing address
100 MARTIN DR, FREDONIA, WI 53021-9455
(262) 692-2461
(262) 692-9889
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4245-015
WI
Other
Enumeration date
06/13/2007
Last updated
08/22/2020
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