Provider Demographics
NPI:1275665325
Name:COTTONWOOD ENDODONTICS PC
Entity Type:Organization
Organization Name:COTTONWOOD ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-278-3636
Mailing Address - Street 1:4252 HIGHLAND DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2670
Mailing Address - Country:US
Mailing Address - Phone:801-278-3636
Mailing Address - Fax:801-424-0833
Practice Address - Street 1:4252 HIGHLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2670
Practice Address - Country:US
Practice Address - Phone:801-278-3636
Practice Address - Fax:801-424-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1404979923261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental