Provider Demographics
NPI:1528038551
Name:MARCOTTE, ALAN DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DOUGLAS
Last Name:MARCOTTE
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 1:810 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2835
Mailing Address - Country:US
Mailing Address - Phone:620-221-7737
Mailing Address - Fax:620-221-2351
Practice Address - Street 1:810 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2835
Practice Address - Country:US
Practice Address - Phone:620-221-7737
Practice Address - Fax:620-221-2351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice