Individual
DR. KEVIN CLYDE POTTER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1804 WARDEN ST, EAU CLAIRE, WI 54703
(715) 834-8484
Mailing address
1804 WARDEN ST, EAU CLAIRE, WI 54703
(715) 834-8484
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3070015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33447500
—
WI
Enumeration date
04/22/2006
Last updated
07/08/2007
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