Organization
WILLIAM J POTTORF DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY DARLEEN POTTORF (SECTY)
(770) 834-7709
Entity
Organization
Contact information
Practice address
406 DIXIE ST, CARROLLTON, GA 30117-3922
(770) 834-7709
(770) 836-9020
Mailing address
406 DIXIE ST, CARROLLTON, GA 30117-3922
(770) 834-7709
(770) 836-9020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10055
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
839004
UNITED CONCORDIA
GA
Enumeration date
02/18/2010
Last updated
02/18/2010
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