Provider Demographics
NPI:1578592333
Name:COOTAUCO, CYNTHIA JOY (DDS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JOY
Last Name:COOTAUCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 BLACKROCK RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3816
Mailing Address - Country:US
Mailing Address - Phone:410-472-4724
Mailing Address - Fax:
Practice Address - Street 1:7939 HONEYGO BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4931
Practice Address - Country:US
Practice Address - Phone:410-931-0250
Practice Address - Fax:410-931-4876
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics