Individual
KELLY G. POTTORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HYGIENST
Contact information
Practice address
1717 BIDDLE ST, SAINT LOUIS, MO 63106-3454
(314) 898-1717
(314) 814-8542
Mailing address
1717 BIDDLE, ST. LOUIS, MO 63107
(314) 898-1717
(314) 814-8542
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2009007073
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2009007073
—
MO
Enumeration date
12/08/2010
Last updated
12/08/2010
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