Provider Demographics
NPI:1215037742
Name:KOTTENSTETTE, JENNIFER N (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:KOTTENSTETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 PASEO DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008
Mailing Address - Country:US
Mailing Address - Phone:719-545-5213
Mailing Address - Fax:719-285-4838
Practice Address - Street 1:1207 PASEO DEL NORTE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-545-5213
Practice Address - Fax:719-285-4838
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice