Provider Demographics
NPI:1972496727
Name:POTTER, HEATHER (RDH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9781
Mailing Address - Country:US
Mailing Address - Phone:916-479-6543
Mailing Address - Fax:
Practice Address - Street 1:1745 W 17TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3618
Practice Address - Country:US
Practice Address - Phone:541-485-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7911124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist