Provider Demographics
NPI:1245384304
Name:BOTTENBLEY, CECIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:
Last Name:BOTTENBLEY
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 1:1776 LINCOLN ST
Mailing Address - Street 2:SUITE #820
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1776 LINCOLN ST
Practice Address - Street 2:SUITE #820
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1022
Practice Address - Country:US
Practice Address - Phone:303-839-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery