Provider Demographics
NPI:1154829224
Name:COTTONWOOD DENTAL CARE
Entity Type:Organization
Organization Name:COTTONWOOD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-547-5744
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-1649
Mailing Address - Country:US
Mailing Address - Phone:530-347-4636
Mailing Address - Fax:530-347-1871
Practice Address - Street 1:3251 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022
Practice Address - Country:US
Practice Address - Phone:530-347-4636
Practice Address - Fax:530-547-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD43003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty