Provider Demographics
NPI:1851479570
Name:COTTRELL, ERIC KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KENNETH
Last Name:COTTRELL
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 1:36 HOMER AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2009
Mailing Address - Country:US
Mailing Address - Phone:518-793-1345
Mailing Address - Fax:518-793-9347
Practice Address - Street 1:36 HOMER AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2009
Practice Address - Country:US
Practice Address - Phone:518-793-1345
Practice Address - Fax:518-793-9347
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY452261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice