Provider Demographics
NPI:1376807537
Name:COTHAM, BRETT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:E
Last Name:COTHAM
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 1:614 E 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-781-6322
Mailing Address - Fax:
Practice Address - Street 1:614 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3905
Practice Address - Country:US
Practice Address - Phone:417-781-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3886122300000X
MO2012015653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012015653OtherSTATE LICENSE
AR3886OtherSTATE LICENSE