Provider Demographics
NPI:1699005124
Name:COTTONWOOD DENTAL LLC
Entity Type:Organization
Organization Name:COTTONWOOD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-382-1890
Mailing Address - Street 1:3327 W CAPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1334
Mailing Address - Country:US
Mailing Address - Phone:308-382-1890
Mailing Address - Fax:308-381-4997
Practice Address - Street 1:3327 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1334
Practice Address - Country:US
Practice Address - Phone:308-382-1890
Practice Address - Fax:308-381-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4294122300000X
NE7101122300000X
NE3813122300000X
NE933124Q00000X
NE2418124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4294OtherDENTIST