Organization
A DENTAL CENTER-DOWNRIVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD POTOCSKY D.D.S (BILLING)
(734) 281-3200
Entity
Organization
Contact information
Practice address
17128 FORT ST, RIVERVIEW, MI 48193-6619
(734) 281-3200
(734) 281-3890
Mailing address
17128 FORT ST, RIVERVIEW, MI 48193-6619
(734) 281-3200
(734) 281-3890
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
17288
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D172880
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/22/2005
Last updated
09/05/2007
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