Provider Demographics
NPI:1174737357
Name:POTTS, ZACHARY LEROY (DDS)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:LEROY
Last Name:POTTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 TIERRA REJADA RD.
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3772
Mailing Address - Country:US
Mailing Address - Phone:805-243-3999
Mailing Address - Fax:805-243-3998
Practice Address - Street 1:4217 TIERRA REJADA RD.
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3772
Practice Address - Country:US
Practice Address - Phone:805-243-3999
Practice Address - Fax:805-243-3998
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist