Provider Demographics
NPI:1891883807
Name:BOTTKE, DAVID P (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:BOTTKE
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 1:2717 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5860
Mailing Address - Country:US
Mailing Address - Phone:319-277-3535
Mailing Address - Fax:319-277-7846
Practice Address - Street 1:2717 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-5860
Practice Address - Country:US
Practice Address - Phone:319-277-3535
Practice Address - Fax:319-277-7846
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0194555Medicaid