Provider Demographics
NPI:1538283239
Name:COTNER, DANIEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:COTNER
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 1:1222 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4729
Mailing Address - Country:US
Mailing Address - Phone:573-335-8533
Mailing Address - Fax:573-335-1095
Practice Address - Street 1:937 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5493
Practice Address - Country:US
Practice Address - Phone:573-335-6022
Practice Address - Fax:573-335-1095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0084961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice