Provider Demographics
NPI:1689708620
Name:COTANT, DAVID A (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:COTANT
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 1:9101 BRIDGEPORT WAY SW
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000037941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8892465OtherMEDICARE MEMBER PTAN
WA5385307Medicaid