Provider Demographics
NPI:1609900638
Name:DAVID A COTANT DDS PS
Entity Type:Organization
Organization Name:DAVID A COTANT DDS PS
Other - Org Name:ORAL AND MAXILLOFACIAL SURGERY OF LAKEWOOD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:COTANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-584-0858
Mailing Address - Street 1:9101 BRIDGEPORT WAY SW
Mailing Address - Street 2:BLDG B2
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2419
Mailing Address - Country:US
Mailing Address - Phone:253-584-0858
Mailing Address - Fax:253-584-1446
Practice Address - Street 1:9101 BRIDGEPORT WAY SW
Practice Address - Street 2:BLDG B2
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2419
Practice Address - Country:US
Practice Address - Phone:253-584-0858
Practice Address - Fax:253-584-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000037941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5355307Medicaid
WACO5448OtherREGENCE