Provider Demographics
NPI:1689978637
Name:IAN M KOTT DDS PC
Entity Type:Organization
Organization Name:IAN M KOTT DDS PC
Other - Org Name:KOTT PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-938-1000
Mailing Address - Street 1:1440 28TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1030
Mailing Address - Country:US
Mailing Address - Phone:303-938-1000
Mailing Address - Fax:303-938-1001
Practice Address - Street 1:1440 28TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1030
Practice Address - Country:US
Practice Address - Phone:303-938-1000
Practice Address - Fax:303-938-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9907122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty