Provider Demographics
NPI:1346741964
Name:COTTER DENTAL PC
Entity Type:Organization
Organization Name:COTTER DENTAL PC
Other - Org Name:DAKOTA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-349-3636
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:ND
Mailing Address - Zip Code:58436-0460
Mailing Address - Country:US
Mailing Address - Phone:701-349-3636
Mailing Address - Fax:701-349-2137
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:ND
Practice Address - Zip Code:58436
Practice Address - Country:US
Practice Address - Phone:701-349-3636
Practice Address - Fax:701-349-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental