Individual
DR. JASON K POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Contact information
Practice address
8220 WALNUT HILL LN, SUITE 206, DALLAS, TX 75231-4427
(214) 930-6588
Mailing address
PO BOX 93982, SOUTHLAKE, TX 76092-0119
(214) 930-6588
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
M6345
TX
174400000X
Specialist
Primary
M6345
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
MD25735
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269840
—
OR
Enumeration date
10/05/2005
Last updated
10/22/2008
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