Provider Demographics
NPI:1164453650
Name:COTTRILL, DWIGHT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:EDWARD
Last Name:COTTRILL
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 1:10238 NE 197TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2452
Mailing Address - Country:US
Mailing Address - Phone:425-483-6839
Mailing Address - Fax:
Practice Address - Street 1:16504 9TH AVE SE
Practice Address - Street 2:SUITE 103
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6396
Practice Address - Country:US
Practice Address - Phone:425-742-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000060881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO6355OtherREGENCE