Provider Demographics
NPI:1093122202
Name:DUCOTE, COLTEN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:COLTEN
Middle Name:
Last Name:DUCOTE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FERN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5688
Mailing Address - Country:US
Mailing Address - Phone:318-797-5812
Mailing Address - Fax:
Practice Address - Street 1:7600 FERN AVE STE 600
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5688
Practice Address - Country:US
Practice Address - Phone:318-797-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64951223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist