Provider Demographics
NPI:1548781701
Name:COTTRELL, CAITLIN SHEA (DMD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SHEA
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3295
Mailing Address - Country:US
Mailing Address - Phone:502-229-9332
Mailing Address - Fax:
Practice Address - Street 1:3946 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1450
Practice Address - Country:US
Practice Address - Phone:502-276-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012841A1223G0001X
KY99691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice