| |
340 Logan St Noblesville IN 46060-1432 | |
(317) 776-0105 | |
(317) 776-0348 |
Full Name | |
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Speciality | Dentist |
Location | 340 Logan St, Noblesville, Indiana |
Authorized Official Name and Position | Faith Moore (OFFICE MANAGER) |
Authorized Official Contact | 3177760105 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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340 Logan St Noblesville IN 46060-1432 Ph: (317) 776-0105 | 340 Logan St Noblesville IN 46060-1432 Ph: (317) 776-0105 |
NPI Number | 1588878326 |
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Provider Enumeration Date | 05/10/2007 |
Last Update Date | 11/25/2008 |
Medicare PECOS PAC ID | 0547321432 |
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Medicare Enrollment ID | O20081210000767 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588878326 | NPI | - | NPPES |
200212660 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12009261 (Indiana) | Primary |
Provider Name | Christopher W Potee |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1972561785 PECOS PAC ID: 9335114834 Enrollment ID: I20040828000182 |
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