Provider Demographics
NPI:1073714317
Name:COTTON, NATHAN L (DMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:L
Last Name:COTTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 E. BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-926-6238
Mailing Address - Fax:
Practice Address - Street 1:917 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5075
Practice Address - Country:US
Practice Address - Phone:509-926-6238
Practice Address - Fax:509-926-6239
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000109681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice